Quick Guide to Depression

Depression is a mental health condition that can cause children and teenagers to feel very sad and hopeless. Kids with depression have trouble enjoying things they used to love. They may also seem listless and easily annoyed.

Depression can have a lot of negative effects on a child’s life, like missing school and not wanting to be around friends. It’s normal for children to feel sad when bad things happen, but a child with depression doesn’t feel better if things change. Kids with depression might think about or attempt suicide.

There are two kinds of depression that a child can be diagnosed with:

• Major depressive disorder: Severe symptoms that last between two weeks and several months
• Persistent depressive disorder (also called dysthymia): Less severe symptoms that last for a year or more

Depression usually begins during the teenage years, but younger kids can also be diagnosed. Girls are diagnosed twice as often as boys.

The biggest sign of depression is a change in mood. A depressed child will feel sad for no reason and lose interest in things they normally enjoy. These changes will last at least two weeks. Other symptoms include:

• Being easily annoyed
• Feeling hopeless
• Lacking energy or seeming lazy
• Trouble concentrating
• Trouble making decisions
• Struggling in school
• Low self-esteem or saying negative things about themselves
• Having trouble talking to friends
• Eating too little or too much
• Gaining or losing a lot of weight
• Being tired all the time
• Trouble sleeping
• Thinking about or attempting suicide

Some children with depression no longer look forward to things they used to enjoy, but they can enjoy them in the moment. This is unusual and is known as atypical depression. It can trick parents, making them think their child doesn’t want to cooperate when they are actually depressed.

Until recently, kids who had been through a major loss (like the death of a loved one) could not be diagnosed with depression. Now, experts acknowledge that such losses can trigger depression, especially if the child has been depressed before.

Depression is diagnosed by a medical professional. To make the diagnosis, they will speak to the child, family members and other adults in the child’s life.

To be diagnosed with major depressive disorder, a child must be depressed most of the time for at least two weeks. They will also have several of the symptoms listed above. Their symptoms must be very different from their normal personality.

To be diagnosed with persistent depressive disorder, a child must be depressed or annoyed most of the time for at least one year. They must also have at least two of these symptoms getting in the way of their daily life:

• Eating too little or too much
• Lacking energy or seeming lazy
• Trouble sleeping
• Trouble concentrating
• Trouble making decisions
• Low self-esteem

In persistent depressive disorder, the symptoms may be more severe at times. They might also get better sometimes, but they do not go away for more than two months at a time. Sometimes, they may be severe enough to be diagnosed as major depressive disorder. When this happens, the diagnosis will be persistent depressive disorder “with intermittent major depressive episodes.” If the major depressive disorder symptoms regularly continue for more than one year, the diagnosis will change to persistent depressive disorder “with persistent major depressive episodes.”

A clinician will also see if the child’s symptoms could have a different cause, such as substance abuse, another psychiatric disorder, or a medical cause like diabetes or hypothyroidism.

The best treatment for depression is a combination of therapy and medication.

Therapy

Two types of therapy are commonly used to treat children with depression:

• Cognitive behavioral therapy (CBT): CBT teaches children how their thoughts shape their feelings and behaviors. The therapist will also encourage them to return to activities they liked in the past. This is called behavioral activation. 
• Interpersonal therapy (IPT): In IPT, the child talks with a therapist about their relationships with friends and family. They learn how these relationships can cause good or bad feelings for the child.

Medication

There are several antidepressant medications that children can take. These include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs). These medications can have side effects, but they are safe for children to use with proper care from their doctor. A child who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

Research has found that taking antidepressants can increase suicidal thoughts in very rare cases. That’s why they have FDA warning labels. However, this is not common and there is no evidence that antidepressants cause actual suicide attempts.

Children with depression are at higher risk for other mental health conditions including anxiety, substance abuse andpanic disorder. 

They are also more likely to attempt suicide. If you think your child or teenager is suicidal, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 or 911 if there is an emergency. Don’t wait — the risk of suicide in children and teenagers is very real.