CLEMSON — Depression in children doesn’t always materialize in “After School Special” histrionics. Some signs can be impossible to discern from everyday teen-dom — difficulty making decisions, irritability, tantrums, etc.

Other indicators are more troubling: unexplained aches and pains, exaggerated changes in eating habits and constant fatigue. Then there are flat-out red flags, low self-esteem, feelings of guilt and hopelessness and social withdrawal.

The occasional blue or foul mood is completely normal, even healthy. They allow youths to process grief or disappointments. But if these behaviors don’t go away and begin to interfere with the young person’s life, a disorder could be brewing.

According to Clemson-based psychologist Dr. David Cannon, it’s important to remember childhood depression is a fairly prevalent problem. Some studies assert one in five people will experience depression by the time they reach adulthood. Cannon believes social issues are often to blame.

“I think even in junior high school the pressures to belong and be a member of an ‘in’ group have grown enormously intense,” Cannon said. “Along with that there seems to be a lot more pressure involving superficial things, such as wearing the right kind of clothes and the right kind of shoes … the whole brand-name phenomenon.”

A family history of depression can inflate occurrence. For example, a child with one depressed parent faces a 50 percent greater chance of being afflicted than a child whose parents aren't depressed, according to the National Institute of Mental Health. If both parents have struggled with depression, the odds rise to 75 percent. Other risk factors for childhood depression include gender, environmental factors and stressful life events.

“Parents need to be willing to be actively involved with their kids,” Cannon said. “In many cases work, careers and other extraneous things at times can pull parents away. Open lines of communication need to be established, making it clear to the young person they, as the parents, are willing to listen and not just preach … to listen and understand if the young person is having difficulty.”

THE SUBPLOT THICKENS

Many depressed children display symptoms of anxiety — worrying too much, fearing being away from a parent — and may be diagnosed as such. In addition, some youths initially diagnosed with depression are later diagnosed with bipolar disorder, a condition in which persons careen from depression to mania.

“Probably the first line of defense is just knowing what the young person is doing and setting reasonable limits,” Cannon said. “A reasonable curfew with hours related to their age. Who are the kids they are spending time with? In actuality, most young people want limits.”

Teenage years often include rituals of exploration, like drinking and drug use. These behaviors can be a Molotov cocktail for psychological issues, such as depression, Cannon said.

“These factors can affect and complicate teenagers’ lives. Certainly drugs and alcohol are far more of a factor that a couple of decades ago, perhaps because of much more peer pressure to get involved in these kinds of activities, that can in turn contribute to depression,” Cannon said.

Sometimes parent-child sit-downs aren’t enough. Destructive tendencies — illegal activity, troubles at school, substance abuse, cutting and other self-injurious actions — are signs professional help may need to be called in.

PILLS, DEMONS, ETC.

Treatment of depression can involve counseling therapy as well as prescriptions drugs. Those decisions should be determined on a case-by-case basis by the child’s parents and therapist. The Food and Drug Association (FDA) advises caution when antidepressants are prescribed for children, teens and young adults due to reports of increased suicidal thoughts and suicide attempts in some of these patients. The FDA strengthened warning labels on all antidepressants for this age group in both 2004 and 2007.

Patients taking antidepressants — particularly young ones — should be monitored — particularly as treatment begins — for deeper depression and development of suicidal tendencies. However antidepressants are used, therapy should also be in the mix, according to the National Institute of Health.

Sometimes depression can be solved away from pills or psychologists’ couches. Pursuing interests — whether it’s painting, dance, basketball or whatever — can give youths a positive, continuing lift.

“Creative and athletic endeavors give the young person a sense of achievement,” Cannon said. “A matter of self-esteem goes along with this sort of activity. It gives them a sense of purpose. Those things can be outlets for energy that might otherwise be spent in negative ways.”

When kids do emerge from depression, that doesn’t mean the door is shut. Twenty to 40 percent of depressed teens relapse within two years — 70 percent by adulthood. The reasons for these trends are not yet known. However, some researchers believe depression can leave behind psychological scars, vulnerable and not so quick to heal.