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Depression in Children and
Teens
What is depression?
Childhood depression is a serious problem. Depression is more than just
feeling down or sad. Even when major disappointments and setbacks make people feel sad and
angry, the negative feelings usually lessen with time. But when depression lasts for weeks
or months and limits a child's ability to function normally, it is called major
depression.
How does it occur?
The exact causes of depression in children and young teens are unclear. It
may be triggered by stressful events like problems at school, troubles with other
children, loss of a friend, parents' divorce, or the death of a pet or family member.
Children with severe learning disabilities, physical handicaps, or medical problems often
develop depression. However, depression can start with no specific cause.
In childhood, both boys and girls are equally at risk. Depression is more
serious when it begins before the age of 10 or 11 and is not the result of a specific
event. During the teen years, girls are twice as likely as boys to develop depression.
Depression runs in families. If you, or others in your family, have had
depression or bipolar disorder then your child is more likely to develop depression.
Some research suggests that depression may be caused by a chemical
imbalance in the brain.
What are the symptoms?
Depression is somewhat different in children and teens than in adults.
Adults usually describe feelings of sadness and hopelessness along with fatigue. Depressed
children are usually more irritable and moody. They may be defiant. They may shift from
sadness or irritability to sudden anger.
Teenagers have to deal with puberty, peers, and developing a sense of
self. In all the confusion, it's easy to miss the signs of teenage depression. Some
children and teens don't know that they are depressed. Instead of talking about how bad
they feel, they may act out. You may see this as misbehavior or disobedience.
A child with symptoms of depression:
• Gets irritated often. Little things make him or her lose his or her
temper or become tense. Your child may have frequent outbursts of shouting or complaining,
or acting reckless.
• May start destroying things such as household items or toys.
• Has low self-esteem, saying things like, "I hate myself"
or "I'm stupid."
• Feels restless, bored, or tired most of the time.
• Loses interest in a lot of the things he or she used to like, such
as music, sports, or being with
friends, and wants to be left alone most of the time.
• Forgets lots of things, and has trouble paying attention. Unlike a
child with attention deficit/hyperactive disorder (ADHD), the depressed child is not
distracted by noises or events, but rather by thoughts or daydreams. Staying on task with
homework can be a major problem.
• May sleep a lot more or have trouble falling asleep at night. Many
depressed children and teens wake up in the middle of the night and can't get back to
sleep.
• Loses his or her appetite, becomes a picky eater, or eats a lot
more.
• Becomes extremely sensitive to rejection or failure. Or your child
rejects others, such as refusing affection from parents or pushing friends away.
• Talks about death and suicide, such as saying, "I wish I were
dead."
• Feels guilty for no reason or believes that he or she is just no
good. Your child may self-injure, for example by biting, hitting, or cutting him- or
herself.
• Doesn't care about rewards or consequences of doing or not doing
chores or homework.
How is it diagnosed?
Many symptoms of depression are also symptoms of other disorders.
Sometimes it is hard to tell depression from other problems such as bipolar disorder,
anxiety, and post-traumatic stress disorder. A mental health therapist who specializes in
working with children and teens is best qualified to diagnose depression. Along with
depression children and teens may have other disorders as well, such as:
• anxiety disorders
• attention deficit/hyperactive disorder (ADHD)
• oppositional defiant disorder (ODD) or conduct disorder (dangerous
anger or violence, destroying property, and stealing).
The mental health professional will ask about your child's behavior and
symptoms, medical and family history, and any medicines your child takes. Sometimes your
child may need lab tests to rule out medical problems such as thyroid disorders.
Diagnosing depression in children is difficult and often requires seeing
your child over weeks or months.
How is it treated?
Both medicines and therapy are useful to treat depression in children and
adolescents.
Cognitive behavior therapy (CBT) helps children learn about depression,
along with teaching skills for managing their physical symptoms, negative thoughts, and
problem behaviors.
Family therapy is often very helpful. Family therapy treats the family as
a whole rather than focusing on just the child. Children often feel very supported when
parents and siblings attend therapy with them and work as a group.
Antidepressant medicines may be needed. Some of the medicines used for
children and teens include fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa),
escitalopram (Lexapro), venlafaxine (Effexor), sertraline (Zoloft), and bupropion
(Wellbutrin). These may help reduce symptoms including irritability and symptoms of
anxiety. If anxiety symptoms continue, then medicines just for anxiety may be added. If
your child also has ADHD, medicines for ADHD may be prescribed.
While rare, antidepressants may make a child or teen more depressed or
even suicidal. It is very important to watch for worsening depression and suicidal
thoughts or behavior, especially when the child first starts taking the medicine. Talk
with your child's prescriber about the risks and benefits of these medicines. In most
cases there are more benefits than risks.
It is important to have an experienced professional working with you and
your child. Symptoms of depression may return. The mental health professional treating
your child may recommend continuing with therapy or medicines even after your child begins
to feel better.
How long will the effects last?
Depression in children may be a one-time problem or may continue. Many
children have trouble for weeks or months. Without treatment, depression may come back and
get worse. With proper medicine and regular therapy, however, the disease is often well
controlled. Many children function normally once a good treatment program is in place.
Children who have had depression are at greater risk for depression in
their late teens and adult years.
What can I do to help my child?
• If your child or teen is suicidal, get
professional help immediately.
• Don't dismiss your concerns if the symptoms have lasted more than 6
weeks. The symptoms may not go away, and may get worse, without professional help.
• Learn all you can. Read, join support groups, and talk with others
who are dealing with depression.
• Understand that you are not responsible for your child's
depression, even if something such as a divorce may have triggered it.
• If your child shuts you out, don't walk away. Let children know
that you are there for them whenever they need you. Remind children of this over and over
again. They may need to hear it a lot because they feel unworthy of love and attention.
• Encourage children to talk about whatever they want to talk about.
Be a good listener. This helps children begin to realize that their feelings and thoughts
really do matter, that you truly care about them, and that you never stopped caring even
when they became depressed.
• Make sure your child takes his or her medicines every day, even if
feeling well. Stopping medicines when he or she feels well may start the problems again.
• Stick to daily routines like regular bed and meal times. Keep
activities very structured and predictable for your child.
• Be firm and consistent with rules and consequences. Staying calm
and in control while you enforce rules and consequences is important with depressed
children.
• Watch your child for the beginning signs of depression. Ask others,
such as school counselors or teachers, to also watch closely.
• Tell all health care providers who treat your child about all
medicines the child takes to make sure there is no conflict with antidepressant medicines.
When should I seek help?
If your child or teenager often has the symptoms of depression listed
above, seek professional help. Do not try to treat these symptoms by yourself.
Professional treatment is necessary. Get emergency care if your child or teenager has
ideas of suicide or harming others or harming him- or herself.
You can get more information from organizations such as:
Depression and Bipolar Support Alliance
Telephone: 800-826-3632
Web site: http://www.dbsalliance.org
National Alliance for the Mentally Ill
Telephone: 800-950-NAMI (6264)
Web site: http://www.nami.org
National Mental Health Alliance
Telephone: 800-969-NMHA (6642)
Web site: http://www.nmha.org
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