By Rita Brhel, managing editor and attachment parenting resource leader (API)

Depression — a mental illness marked by unrelenting sadness and hopelessness that permeates the lives of an estimated one in 18 people — is among the most prevalent medical disorders in today’s world, affecting 12 percent of women, 7 percent of men, and 4 percent of adolescents in a given year. Eight percent of adults will develop depression sometime in their life, and women are most prone — their lifetime risk is 20 percent.

Depression is a devastating illness. In its mildest form, it drains the happiness out of a person’s life. In its most severe form, depression kills. It can lead to suicide or, in cases where depression symptoms manifest as anger and rage, as assault or worse.

Treatment of depression, overall, is usually complicated. There are many severities of depression, from mild but chronic to seasonal affective disorder to anxiety to major depressive episodes. Chemical imbalances in the brain often contribute to the development of depression, but that is rarely the only cause. Additional contributing factors may include recent events such as a death in the family or a job loss; a traumatic upbringing, such as a childhood marred by abuse; low self esteem; major life changes, such as a new baby or moving to a new city; natural disasters; physical illness; and others. Therefore, treatment often includes not only medication but also long-term counseling; very severe forms of depression can also lead to hospitalization.

Depression in Infants

It has long been debated whether infants can develop depression, particularly young infants whose social interactions and life experiences are limited, but during the past few years, mainstream research has increasingly found infants as young as six months old capable of showing classic signs of depression, according to the 2006 article, “Depression in Babies and Young Infants” by Beth McHugh at http://mental-health.families.com..

In much of the research, according to the article, infants were are more likely to exhibit depressive behaviors when their own mothers suffered from depression. Symptoms of depression in infants include:

• Lack of responsiveness and interaction with others;
• Lack of interest in the environment;
• No smiling or laughing;
• Lack of eye contact;
• Slow movements and lethargy, yet irritability;
• Problems with sleeping and eating;
• Development delays and regression; and
• Falling off growth curves.

These behaviors are found in depressed infants whether the baby is interacting with a person who is depressed, or one who is not. However, diagnosis can be elusive, as depression can be easily confused with attachment disorders and non-organic failure to thrive — and can in fact lead to failure to thrive, a disorder that leads to severe growth and developmental delays and even death in severe cases, according to the 2008 Neuro-Vision.us article, “Postpartum Depression: When Infants Fail to Thrive,” by Alan Densky.

What causes depression in infants? Unlike older children and adults, infants do not have a background of negative life experiences to contribute to a depression. The cause is unclear, although researchers suspect depression is due to early interaction with the depressed mother and/or a genetic tendency, according to McHugh’s article. Some infants may even be born depressed if they were exposed to high levels of the stress hormone, cortisol, as a result of pregnancy complications or prenatal depression in the mother, according to an article in the March 2008 issue of the BeginningsGuides.net newsletter, “Can Young Babies be Depressed?” by Sandra Smith.

The focus of the article you are reading is infants of depressed mothers who then tend to exhibit depressive behaviors, a phenomenon described in the Comprehensive Handbook of Personality and Psychopathology by Michel Hersen and Jay Thomas.

“Observations of depressed mothers interacting with their children reveal that these mothers are more negative and controlling, are less responsive and affectively involved, and use less productive communications,” according to Hersen and Thomas. “Depressed mothers spend less time talking to and touching their babies and show more negative affect in their interactions with their infants, who themselves show less positive affect, less activity, and more frequent protests. Such behaviors by depressed parents can lead to disturbed attachment and an inability by infants to regulate emotions, thereby putting the infant at risk for depression. Thus, negative reciprocal interaction patterns also tend to develop between depressed mothers and their children.”

The Role of Parent-Child Interaction in Infant Depression

Attachment research clearly shows a definitive link between poor parent-child interaction and an adverse effect on the child’s well-being, developmentally and emotionally. With infants, the depression is often precipitated by interactions with a depressed mother, which causes the mother to struggle to meet the baby’s needs. In cases where the mother is severely depressed, she may neglect her baby. Her unpredictable responsiveness leads to a frustrated baby.

Research, as pointed out in Smith’s article, shows that infants as young as three months old can detect depression in their mothers, and that they respond with a depressed mood. In fact, one study from the University of California at Los Angeles found that infants of mothers who are depressed longer than two months are more likely to experience a slowed or, possibly halted, weight gain, as featured in a 2007 HealthAtoZ.com article by Melissa Tennen, “Better to Treat Depression in Moms.”

Infant depression resulting from depression in the mother can be alleviated when fathers and other loving adults step in provide care to the baby while the mother seeks treatment and recovers, according to Smith’s article. Once the depressed mother is relieved, the prognosis for the depressed infant depends on his personality. Some babies respond quickly to interaction with loving, non-depressed adults, but other babies require more time to heal.

Music therapy and infant massage have both been found to aid in treatment of depression in infants. According to the article “Touch in Labor and Infancy” in the online Hong Kong Journal of Paediatrics, Hkjpaed.org, massage has been shown to decrease certain stress hormones and brain chemicals in infants of depressed mothers. In many cases, mental health professionals advocate family psychotherapy to help caregivers learn to identify how their interactions with the infant are affecting his mood.

If the mother-infant interaction does not change to allow treatment of depression, over the long term, the baby learns that this type of interaction is “normal,” which may result in depression during childhood. Writes Smith: “[Childhood depression] could be an outcome of attachment disorganization in infancy, since depression and disorganization seem to share the same learned helplessness.”

Signs of depression in toddlers, from one to three years old, include:

• Sad or expressionless face;
• Lack of eye contact;
• Regular staring;
• Limited social play;
• Feeding problems;
• Sleeping problems;
• Tantrums and irritability;
• Lethargy and a lack of interest in peer activity;
• Separation anxiety and attachment problems.

Many of these signs are a normal part of living with a toddler, but when a parent notices a long-term change in her child’s mood or behavior — such as a child who seems to have become irritable most of the time — an illness is suspect, including depression.

Depression in children that begins in the childhood years is more likely to be caused by a new event, but depression in children that is the continuation of infant depression is more likely to be the result of a learned pattern of interaction between the child and his primary caregiver. This is why it is so important to take the time to heal the relationship between a mother and her infant, in addition to treating the mother’s depression.

“Some experts say that depression in a child must last a year to be considered depression. But if the depression occurs during the first three years of life when the brain develops the fastest, a year could be too long,” writes Tennen in another 2007 HealthAtoZ.com article, “Babies Can Get Depressed, Too,” “The brain spins new neurological pathways full of memories and behaviors that are mostly set for life. Depression in an infant cripples a child’s development.”

A strong parent-child attachment is crucial in both preventing and treating depression. Attachment is interrupted by the depression in the mother. If treated, and the mother-baby relationship is allowed to heal, the infant is unlikely to carry his depression with him into childhood.

However, if left untreated, those continued poor interactions between the mother and child reinforce the depressive behaviors in the child. In fact, the longer a person is depressed, the more difficult it is to treat — not only because the person develops hard-to-break habits and views of who he is, but also because the depression affects the chemicals in his brain. At this point, depression basically becomes part of his personality. In some cases, untreated depression that involves an imbalance of brain chemicals can lead to an irreversible imbalance and become chronic.

Depression in the Growing Child

It’s difficult to imagine a child developing depression, when their life experiences are shallow compared to that of an adult. Abuse and neglect spring to mind as causes of depression in children. However, this is not always the case.

It’s estimated that 10 percent of children ages 6-12 are affected by depression, with more children developing this disorder as they age. Twelve percent of children ages 9-12 are depressed, and only 1 percent of children ages 1-6 are affected by depression, according to a 2001 OregonCounseling.org article by Michael Conner, “Understanding and Dealing with Depresesion (Ages 6 to 12 Years Old).” The severity can range from major depression to a chronic, mild form to separation anxiety disorder to problems adjusting to change.

Just as in adolescents and adults, symptoms of depression in children include:

• Crying and feeling sad, helpless, or hopeless;
• Feeling discouraged or worthless;
• Loss of interest or pleasure in others or most activities;
• Fatigue and loss of energy most days;
• Bad temper, irritability, and annoyed easily;
• Fearful, tense, or anxious;
• Repeated rejection by other children;
• Drop in school performance;
• Fidgeting, pacing, or inability to sit still;
• Repeated emotional outbursts, shouting, or complaining;
• Doesn’t talk to other children;
• Repeated physical complaints without medical cause, especially headaches, stomach aches, and aching arms or legs;
• Significant and unexplained increase or decrease in appetite;
• Change in sleep habits.

And, just as in adolescents and adults, children can have suicidal thoughts or actions, self-harming behavior, alcohol or substance abuse, and depression coupled with strange or unusual behavior, such as paranoia or hallucinations. Children as young as four have been put on medication to prevent suicidal thoughts.

The cause of depression in children can be evident, such as a death of a loved one or divorce, but in others, the cause is not readily apparent. Just as in adolescents and adults, the cause may actually be several factors. Besides actual events, other contributing factors to depression in children include:

• Deficit social skills;
• A lack of family cohesion, expressiveness, and organization;
• Family conflict;
• Deficit ability in self-monitoring, self-evaluation, and self-reinforcement;
• Negative views of self, the world, and the future;
• Learned helplessness;
• Deficit problem-solving skills.

And, just as in adolescents and adults, the treatment can be complex, including not only medications and counseling but also behavioral therapy and training in social skills.

AP as a Tool for Preventing Childhood Depression

Depression in infants and young children is unnecessary and can be tragic to their development, and requires immediate attention. But, more importantly, parents must focus on preventing the possibility of depression in their infants from continuing into their childhood. This brings us back to the Theory of Attachment — that strong emotional bond between parent and child that involves consistent exchanges of compassionate acts of caring, comforting, and affection. Researcher John Bowlby found that early experiences in childhood play a vital role in development and behavior later in life. These experiences between the parent and child, over the long term, create the attachment in that relationship.

The solution for healing the relationship between an infant and his mother is working to strengthen the attachment bond. Parents can find ways to do this through API’s Eight Principles of Parenting, such as breastfeeding or bottle-nursing, co-sleeping, and babywearing. Consistent, loving care and responding with sensitivity develop into a foundation for the mother-child bond: The infant grows to trust his mother to respond to his needs and therefore thrives, and the mother becomes confident in her parenting ability and feels fulfilled in her role.

Attachment Parenting also helps to prevent childhood-onset depression. According to Elizabeth Stock of the Rochester Institute of Technology in her 2003 article, “The Effect of Parental Attachment on Child Psychological Disorders,” written as a peer commentary on a paper discussing childhood depression at PersonalityResearch.org, strong emotional attachment has a profound effect on the mental well-being of children. Children who have insecure attachment with their parents are much more likely to develop depression.

“What is ‘secure attachment’? To a child, it is the feeling of confidence that his or her needs will be met consistently, sensitively, and lovingly. It is the knowledge that he is loved and appreciated for who he is, not on condition of how well he is behaving, or other conditions of approval.”
~ API Co-founder Barbara Nicholson in “The Attachment Cycle”

Children need to know that their care is constant, and that they are accepted by their parents as they are. They need to know that their parents will provide them with compassionate, empathetic responses to their life stresses, especially as they age and enter school and the challenges of peer interaction, encounter puberty, and eventually leave home for adulthood. Strong parent-child attachment is key to providing children with a promising future of fulfilled expectations and the emotional tools to combat the effects of stress to prevent adolescent and adult depression.