Depression in Children and Teens

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KEY POINTS

• Depression is a condition in which children and teens feel sad, hopeless, and uninterested in daily life.
• Both medicines and talk therapy are useful to treat depression in children and teens.
• Ask children or teens if they are feeling suicidal or have done anything to hurt themselves. Get emergency care if your child or teen has ideas of suicide or harming others or harming himself.

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What is depression?

Depression is a condition in which children and teens feel sad, hopeless, and uninterested in daily life. The depression may keep them from doing everyday activities.

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.

Children who have had depression are at greater risk for depression in their late teens and adult years.

What is the cause?

The exact cause of depression is not known.

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way your child thinks, feels, or acts. Children with this disorder may have too little or too much of some of these chemicals.
• Depression tends to run in families. It is not known if this is caused by genes passed from parent to child. It may also be that parents have a negative outlook, and children learn this behavior from the parents.
• It may be triggered by stressful events like problems at school, being bullied, loss of a friend, parents' divorce, or the death of a pet or family member. Abuse, neglect, poverty, or being homeless also increases the risk for depression.
• Children with severe learning disabilities, physical handicaps, or medical problems often develop depression. However, depression can start with no specific cause.

Depression is more serious when it begins before the age of 10 or 11 and is not the result of a specific event. In childhood, both boys and girls are equally at risk. During the teen years, girls are twice as likely as boys to develop depression.

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. Their mood may shift from sadness to irritability or sudden anger. 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 depression may:

• Get irritated often, lose his temper, have frequent outbursts of shouting or complaining, or act recklessly
• Destroy things such as household items or toys
• Say things like, "I hate myself" or "I'm stupid"
• Lose interest in the things he used to like and want to be left alone most of the time.
• Forget things, have trouble concentrating, and let the quality of schoolwork go down
• Sleep a lot more, have trouble falling asleep at night, or wake up at night and not be able to get back to sleep
• Lose his appetite, become a picky eater, or eat a lot more than usual
• Be extremely sensitive to rejection or failure
• Feel guilty for no reason or believe that he is just no good. Your child may hurt himself, such as biting, hitting, or cutting himself
• Start using alcohol and drugs
• Talk about death and suicide, such as saying, "I wish I were dead"

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. Teens with depression may also have symptoms such as often being angry, having problems in school, breaking the rules, and withdrawing from friends and family.

How is it diagnosed?

Your child's healthcare provider or a mental health therapist will ask about the child's symptoms, medical and family history, and any medicines the child is taking. He or she will make sure that your child does not have a medical illness or drug or alcohol problem that could cause the symptoms.

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.

How is it treated?

Both medicines and talk therapy are useful to treat depression in children and teens. If anyone is hurting your child physically or sexually, or if your child is being threatened, harassed, or bullied, the counselor can take action to help keep your child safe.

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.

Several types of medicines can help treat depression. If your child also has anxiety or ADHD, then medicine to treat those problems may be prescribed. Your child’s healthcare provider will work with you to select the best medicine for your child.

While rare, antidepressants may make a child or teen manic (feeling highly energized and being very active), more depressed, or even suicidal. It is very important to watch for new or worsening symptoms, especially when the child first starts taking the medicine. Talk with your child's healthcare provider about the risks and benefits of these medicines. In most cases there are more benefits than risks.

How can I help my child?

• Support your child. 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. 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.

  Ask your child if he is being bullied, hurt, or made to feel bad by anyone. Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.

• Be consistent. Understand that you are not responsible for your child's depression, even if something such as a divorce may have triggered it. Be firm and consistent with rules and consequences. Your child needs to know that the rules still apply to them. It does not help to teach children that they can avoid consequences if they’re depressed.
• Help your child learn to manage stress. Teach children and teens to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks.
• Take care of your child’s physical health. Make sure your child eats a healthy diet and gets enough sleep and exercise every day. Teach children and teens to avoid alcohol, caffeine, nicotine, and drugs.
• Check your child’s medicines. Tell all healthcare providers who treat your child about all medicines your child takes, to make sure there is no conflict with antidepressant medicines. Make sure your child takes his medicines every day, even if feeling well. Stopping medicines when he feels well may start the problems again.
• Contact your healthcare provider or therapist if you have any questions or your child’s symptoms continue or get worse.

Ask children or teens if they are feeling suicidal or have done anything to hurt themselves. Get emergency care if your child or teen has ideas of suicide or harming others or harming himself.

For more information, contact:

• National Institute of Mental Health
  866-615-6464
  https://www.nimh.nih.gov/index.shtml
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/
• Depression and Bipolar Support Alliance
  800-826-3632
  http://www.dbsalliance.org