My husband and I are struggling with our five-year-old daughter, who has been diagnosed as depressed by our family therapist. She has always been intense and persistent. It's very difficult to get her out of her "funks." The start of full-day kindergarten recently went well at first, but on the 11th day she started crying and said she didn't want to go to school anymore because she missed us. She cries every morning and anticipates the next day filled with worry, she no longer loves playing with friends and imaginary games. We tell her, "let's fight the sadness monster together," and, "we're going to beat this together because our team is called the Happy Hopers!" She says she doesn't always want to be sad, but "can't help it." We are in family therapy and have also been meeting with the school guidance counselor and teacher for a uniform approach. We have also made an appointment with a pediatric psychopharmacologist to discuss antidepressant medication. How do you know when it's time to try medication? What do you say to a five-year-old who says she "can't"?
To see depression in one so young is deeply troubling; unfortunately, childhood depression, in every age group, is on the rise. Your help will be vital to her learning to manage her moods, since she is already showing the helplessness and hopelessness so typical of depression. Your daughter is also showing anxiety, another basis for serious concern.
From my perspective, given what is known—and especially what is not known—about the use of medications in children, especially young children, I would suggest that medication be considered an option only after good therapy alternatives have been tried but have not been successful. Medications can be helpful, of course, but similar, and potentially longer-lasting, gains can usually be made through less invasive means. It's difficult to judge when an approach has been tried long enough before abandoning it as ineffective, since many effective approaches don't produce immediate results. The professionals you're working with can help define a reasonable length of time for evaluating the effectiveness of current approaches. However, there are important treatment targets that may not yet have been addressed.
To date, only one medication has been approved for children—Prozac. But there are no good data on its long-term effects (or those of the other antidepressants) on young children's nervous systems or their physical or social development. Medicating children is still an experiment. I'd be reluctant to do it until I felt confident that everything else had been tried.
In psychotherapy, I'd urge you to address your daughter's perceptions of helplessness, her low frustration tolerance in approaching tasks, her difficulty adjusting to school and managing her anxiety about it, and the ongoing self-focus on "how she feels today."
On one level, calling her feelings the "sadness monster" seems a supportive strategy. On a deeper level, though, she is learning that her feelings are enduring and formidable—even parts of her to be feared because they are "monstrous." Her emotions now have form and substance, a life all their own, which may prevent her from learning how to cope with them. She is being unintentionally reinforced for expressing and succumbing to her fears, rather than learning how to manage and transcend them. Start talking to her instead about how her feelings are a part of her but not all of her; they vary, they are potentially useful as teachers, and they can't completely define her.
A big problem with depression sufferers of any age is "internal orientation." The person focuses on his or her feelings and then uses those feelings as the index of how they're doing and for deciding what to do. You are unintentionally reinforcing your daughter's self-focus and helping her use her feelings as a main frame of reference for what to do.
How will she learn she is more than her feelings? How will she learn to make decisions and take effective action regardless of how she feels, since sometimes feelings only get in the way of other important goal-oriented pursuits? Feelings can't always be the frame of reference for what to do (although sometimes they can; the wisdom is in knowing when to use your feelings as a guide, and when not to). Otherwise, a person can function only when she or he feels good.
You can use everyday examples of action over rumination, goals over feelings as a model for your daughter: For example, you can talk about how "Mommy goes to work even when she doesn't want to sometimes because it's an important responsibility." Teach your daughter how to do things, to devise sequences of effective behavior that are not dependent on her mood. When she says, "I can't," you can discuss what someone would do, step-by-step, if they could. Then walk her through those steps.
Five years old is not too young for you to start teaching self-management skills. It's how emotionally healthy children acquire the all-important skills of frustration tolerance and impulse control. It's how children learn to manage disappointment...
For more perspective, please read my book Hand-Me-Down Blues: How to Stop Depression From Spreading in Families as well as The Optimistic Child by Martin Seligman and How to Raise an Emotionally Intelligent Child by John Gottman.
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