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Depression in Children and Teens

What is depression?

Depression is a very real concern for children and teens. It can affect how a child thinks, feels and behaves. Lots of experiences growing up can lead to ups and downs. But for some children, these negative thoughts are not temporary. When that’s the case, they are a symptom of depression. About one in five teens will experience depression at some point.

Depression is often thought of as an adult illness and not always recognized when it affects children and adolescents, but depression produces persistent symptoms which interfere with their ability to live. Recognizing the symptoms is the first step towards recovery.

How common is depression in children and teens, and who is at risk?

Depression is often thought of as an adult illness and not always recognized when it affects children and teens, but depressionís persistent symptoms interfere with a young personís success at home and school. The National Institute of Mental Health (NIMH) estimates that approximately 11 percent of adolescents have a depressive disorder by age 18.

During childhood, the number of boys and girls affected by depression are almost equal. In adolescence, twice as many girls as boys are diagnosed. Well over one-half of depressed adolescents have a recurrence within seven years.

Children and teens who are at higher risk for depression include those who have attention deficit/hyperactivity disorder, conduct, learning or anxiety disorders and oppositional defiance disorder. Experiencing considerable stress, trauma, facing a significant loss or a family history of mood disorders increases a young person’s risk.

What are the symptoms and warning signs of depression in children and teens?

Children and teens will often express depression differently than adults. If one or more of these signs persist, parents should seek professional help:

  • Difficulty with relationships.
  • Increased irritability, anger or hostility.
  • Extreme sensitivity to rejection or failure.
  • Low self-esteem and guilt.
  • Social isolation, poor communication.
  • Persistent boredom; low energy.
  • Hopelessness.
  • Decreased interest in activities; or inability to enjoy previously favorite activities.
  • Frequent sadness, tearfulness, crying.
  • Frequent complaints of physical illnesses such as headaches and stomachaches.
  • Frequent absences from school or poor performance in school.
  • Poor concentration.
  • A major change in eating and/or sleeping patterns.
  • Talk of or efforts to run away from home.
  • Thoughts or expressions of suicide or self-destructive behavior.

Grade-school children are more likely to complain of aches and pains than to say they are depressed. Depressed teens may become aggressive, abuse drugs or alcohol, do poorly in school or run away. In contrast to outward appearances, on the inside they are often experiencing feelings of isolation, emptiness and hopelessness.

Episodes of depression in children last six to nine months on average, but in some children they may last for years. When children are experiencing an episode they may struggle at school, have impaired relationships with their friends and family, internalize their feelings and even have an increased risk for suicide.

Suicide is the third-leading cause of death among children aged 15 to 19. It is essential for young people with severe symptoms or those lasting several weeks to be evaluated by doctors. If your teen is having suicidal thoughts, get help right away. You can call the National Suicide Prevention Lifeline at (800) 273-TALK (8255) to reach a trained professional or you can encourage your child to do so.

What are the treatments for children and teens with depression?

Studies have shown both therapy and medication to be useful in treating children and teens who are depressed. However, all treatment options have risks and benefits. The best strategy is to educate yourself about the choices, share decisions with your child or teen and evaluate choices.

Psychosocial treatments. Psychosocial treatments include individual therapies, psychoeducation, self-help and support groups and are helpful in providing guidance, support and education to children and adolescents living with depression and their families. Cognitive behavioral therapy (CBT), which concentrates on changing the negative attributional bias (seeing every cup as half-empty) associated with major depression, has been very effective in treating depression. Interpersonal therapy (IPT) is also effective and focuses on a patient's self-concept and relationships with peers and family.

Psychoeducation. Psychoeducation and family psychoeducation have also proven to be beneficial for children 8 to12 years old with depression. The NAMI Basics education program is an example of psychoeducation designed for children and families. The program focuses on strengthening, supporting and empowering caregivers.

Medications. Medications can be an effective treatment option for child and adolescent depression, but it also carries risks. Fluoxetine (Prozac) is the only antidepressant specifically approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children ages 8 and older. Doctors can prescribe other antidepressant medications “off label” (not specifically approved by the FDA for the condition). If a doctor suggests another medication, it is a good idea to ask more questions.

How long a young person needs treatment is determined by the improvement and severity of symptoms. Many therapists will decrease the frequency of psychotherapy sessions but continue some maintenance therapy longer than the initial eight to 12 weeks of treatment. Treatment for a first episode of depression is likely to last at least six to 12 months with either treatment but may be longer. For recurring depression, many doctors will recommend a person stay on medication for considerably longer periods to prevent a recurrence.

Are there any special treatment considerations for children and teens?

Suicidal thoughts are a concern for young adults with depression. It is important to have regular care assessments, monitoring and follow-up, particularly in the first months of medication treatment. The FDA has issued a strong “black box” warning about the risk of increased suicidal thoughts and actions in a small percentage young people under the age of 25.

Bipolar disorder is also a concern. Children and adolescents who first experience a major depressive episode may, over time, be predisposed to bipolar disorder.

How can I help my child and support their treatment?

You and your family can provide the caring support and gentle guidance they need as your child adjusts to living with depression.

Here are some things you can do to help:

  • Help your young person stick to their treatment plan. Make sure they get to appointments and take medication as prescribed. Many young people will question if they still need the medication when they have a period of improvement or are unhappy with some side effects.
  • Learn about depression. Knowledge will help you and your child overcome many aspects of the illness.
  • Communicate openly. Listen to your child or teenagers by allowing them space to express how they feel without judging them.
  • Pay attention to warning signs. Working with your child and the treatment team find ways to identify, avoid and handle triggers.
  • Engage in a healthy lifestyle. Exercise or physical activity help to lift mood. Sleeping well and eating nutritious foods are important to wellness and reduce symptoms.
  • Help your teen avoid alcohol and other drugs. Some teens feel like alcohol or drugs lessen depression symptoms, but in the long run they only worsen their depression and make it harder to treat.

Taking care of yourself and the rest of the family is important. Depression is a challenging mental health condition. Everyone will experience a wide range of emotions and move through different stages of acceptance. It helps to know that you are not alone. NAMI is there to offer your family support, insights and encouragement. NAMI education programs, family support groups are offered nationwide. Your local NAMI Affiliate will put you in touch with people in your community that can help.

Reviewed by Ken Duckworth, M.D., May 2014

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