Furthermore, the very definition of being a child—what makes him survive and grow—is being able to move up and down emotionally, having a basic elasticity. Says Dr. Peter Jensen, child and adolescent psychiatrist at the National Institute of Mental Health: "A child is more fluid and plastic than an adult. A child may look depressed one day because his dog died but seem O.K. three days later."

But if parents live in a world of family mood swings, that doesn't mean they are prepared to put their own child on mind-altering drugs. That prospect can lead to major soul searching: Will they be thought less of as parents? And if they do agree to antidepressants, will the child still be the one they know?

Donna Mitchell was told her daughter, eight-year-old Sawateos, had attention-deficit hyperactivity disorder, but she also showed signs of serious depression and anxiety, which are often found in combination. Mitchell's first reaction was, "I can pray this away. I thought, Listen, nobody in my family is going on drugs. That's an insult. I figured all we needed was family talks." But two years after the diagnosis, Mitchell has agreed to put her child on the ADHD drug Ritalin. She still resists the idea of antidepressants. It's her preteen daughter who's making the case for doing it. "Mama, it's in our genes," Sawateos tells her.

All this may help explain why it is so hard for the people closest to children to detect that anything is really wrong. Studies show that parents consistently miss the signs of depression. In one survey by researchers at Ball State and Columbia universities, 57% of teens who had attempted suicide were found to be suffering from major depression. But only 13% of the parents of suicides believed their child was depressed.

Diagnosis is critical because depressed children tend to develop increasingly severe mental disorders and in some cases psychosis as teens and adults. Three studies on children who were depressed before puberty show that as adults they had a higher rate of antisocial behavior, anxiety and major depression than those who experienced their first depressive episode as teens. "Prepubertal depression does occur, and those who get it are more susceptible to [the] mania [of bipolar disorder] later," says Dr. John March, director of the program on pediatric psychopharmacology at Duke University. "The earlier you get it, the more likely you will develop chronic depressive and anxiety symptoms."

So how do psychiatrists pick out kids who are depressed from those who are simply moody? In his book Help Me, I'm Sad, Fassler lists a number of physical symptoms in three age groups—preschoolers, young school-age children and adolescents. Among preschoolers, the signs include frequent, unexplained stomachaches, headaches and fatigue. Depressed school-age children frequently weigh 10 lbs. less than their peers, may have dramatic changes in sleep patterns and may start speaking in an affectless monotone. Adolescents go through eating disorders, dramatic weight gains or losses, promiscuity, drug abuse, excessive picking at acne, and fingernail biting to the point of bleeding.

Fassler cautions that none of these symptoms may ever be present and a whole constellation of more subjective manifestations must be considered. Adults and adolescents share many of the same warning signs—low self-esteem, tearfulness, withdrawal and a morbid obsession with death and dying. Among adolescents, however, depression is often accompanied by episodes of irritability that, unlike mood swings, stretch for weeks rather than days.

Dr. Elizabeth Weller, professor of psychiatry and pediatrics at the University of Pennsylvania, has developed techniques for detecting depression in kids. First she establishes a rapport with a child. Then she asks, for example, whether he still has fun playing softball or whether it is taking him longer to finish his homework—both of which are ways to figure out whether the child has lost motivation and concentration. Crying is another marker for depression, but Weller says boys rarely admit to it. So she asks them how often they feel like crying.

She then quizzes parents and teachers for other signs. Parents can tell her if a child no longer cares about his appearance and has lost interest in bathing or getting new clothes. Teachers can tell her whether a child who used to be alert and active has turned to daydreaming or has lost a certain verve. As Weller puts it, "Has the bubble gone out of the face?"

There are several other complicating factors. Some psychiatrists believe depression in younger children often appears in conjunction with other disorders. "Many depressed kids," notes Fassler, "are initially diagnosed with ADHD or learning disabilities. We need to separate out the conditions and treat both problems." But there's a chicken-and-egg problem here: antisocial behavior or a learning disability can lead a child to become isolated and alienated from peers and thus can trigger depression. And depression can further interfere with learning or bring on antisocial behavior.

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