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This topic covers depression in children and teens. For information about depression in adults, see the topic Depression. For information about depression with episodes of high energy (mania), see the topic Bipolar Disorder in Children and Teens.
Depression is a serious mood disorder that can take the joy from a child's life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.
Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. As many as 2 out of 100 young children and 8 out of 100 teens have serious depression.1
Still, many children don't get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.
If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. If you think your child is depressed, talk to your doctor or a counselor. The sooner a child gets treatment, the sooner he or she will start to feel better.
A child may be depressed if he or she:
A child who is depressed may also:
The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.
Also, the symptoms may be different depending on how old the child is.
Depression can range from mild to severe. A child who feels a little "down" most of the time for a year or more may have a milder, ongoing form of depression called dysthymia (say "dis-THY-mee-uh"). In its most severe form, depression can cause a child to lose hope and want to die.
Whether depression is mild or severe, there are treatments that can help.
Just what causes depression is not well understood. But it is linked to a problem with activity levels in certain parts of the brain as well as an imbalance of brain chemicals that affect mood. Things that may cause these problems include:
To diagnose depression, a doctor may do a physical exam and ask questions about your child's past health. You and your child may be asked to fill out a form about your child's symptoms. The doctor may ask your child questions to learn more about how he or she thinks, acts, and feels.
Some diseases can cause symptoms that look like depression. So the child may have tests to help rule out physical problems, such as a low thyroid level or anemia.
It is common for children with depression to have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems to help your child get the right diagnosis and treatment.
Usually one of the first steps in treating depression is education for the child and his or her family. Teaching both the child and the family about depression can be a big help. It makes them less likely to blame themselves for the problem. Sometimes it can help other family members see that they are also depressed.
Counseling may help the child feel better. The type of counseling will depend on the age of the child. For young children, play therapy may be best. Older children and teens may benefit from cognitive-behavioral therapy. This type of counseling can help them change negative thoughts that make them feel bad.
Medicine may be an option if the child is very depressed. Combining antidepressant medicine with counseling often works best. A child with severe depression may need to be treated in the hospital.
There are some things you can do at home to help your child start to feel better.
Antidepressant medicines often work well for children who are depressed. But there are some important things you should know about these medicines.
Learning about depression in children and teens:
Living with depression in children and teens:
Health Tools help you make wise health decisions or take action to improve your health.
Depression is thought to be caused by an imbalance of chemicals called neurotransmitters that send messages between nerve cells in your brain. Some of these chemicals, such as serotonin, help regulate mood. If these mood-influencing chemicals get out of balance, depression or other mood disorders can result. Experts have not yet identified why neurotransmitters become imbalanced. They believe a change can occur as a response to stress or illness. But a change may also occur with no obvious trigger.
There are several things known to increase the chances that a young person may become depressed.
The symptoms of depression are often subtle at first. They may occur suddenly or happen slowly over time. It can be hard to recognize that symptoms may be connected and that your child might have depression.
It's important to watch for warning signs of suicide in your child or teen. These signs may change with age. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.
Depression can have symptoms that are similar to those caused by other conditions.
Severely depressed children may also have other symptoms, such as:
Telling the difference between normal moodiness and symptoms of depression can be hard. Occasional feelings of sadness or irritability are normal. They allow the child to process grief or cope with the challenges of life.
For example, grieving (bereavement) is a normal response to loss, such as the death of a family member or even the death a pet, loss of a friendship, or parents' divorce. After a severe loss, a child may remain sad for a longer period of time.
But when these emotions do not go away or begin to interfere with the young person's life, he or she may need treatment.
Some children who are first diagnosed with depression are later diagnosed with bipolar disorder. Children or teens with bipolar disorder have extreme mood swings between depression and bouts of mania (very high energy, agitation, or irritability).
It can be hard to tell the difference between bipolar disorder and depression. It is common for children with bipolar disorder to first be diagnosed with only depression and later to be diagnosed with bipolar disorder after a first manic episode. Although depression is part of the condition, bipolar disorder requires different treatment than depression alone.
Like depression, bipolar disorder runs in families. So be sure to tell your doctor if your child has a family history of bipolar disorder. For more information on bipolar disorder, see the topic Bipolar Disorder in Children and Teens.
At first, depression in a child or teen may appear as irritability, sadness, or sudden, unexplained crying. He or she may lose interest in activities enjoyed in the past or may feel unloved and hopeless. He or she may have problems in school and become withdrawn or defiant.
An episode of depression lasts an average of 8 months.1 Even with successful treatment, as many as 40 out of 100 children with depression will have another episode within a few years.2
Less than half of children and teens with depression receive treatment.3 This may be partly due to the old belief that young people don't get depression.
Also, teens often do not seek help for depression. They may think feeling bad is normal, or they may blame something else (or themselves) for their symptoms. Or they may not know where to go for help. Tell your child to ask for help if he or she feels bad. And let your child know who to go to for help with depression or other problems.
Some teens will have alcohol or drug use problems along with depression. When this happens, depression is harder to treat, and it can take longer for treatment to work. Drug or alcohol use also increases the risk of suicide.
Early diagnosis and treatment of depression and good communication with your child can help prevent substance abuse. For more information about substance abuse in young people, see the topic Teen Alcohol and Drug Abuse.
Often a child who is depressed will have other disorders along with depression, such as an anxiety disorder, a behavior disorder like attention deficit hyperactivity disorder (ADHD), an eating disorder, or a learning disorder.
These problems may occur before a young person becomes depressed. Some children with depression develop serious behavior problems (conduct disorder), often after becoming depressed. If your child has one of these disorders, it may require treatment along with depression.
Children and teens with depression are also at a higher risk for problems such as:
For severe depression, your child may need to be hospitalized, especially if he or she is out of touch with reality (psychotic) or is having thoughts of suicide.
During treatment for depression, make sure that your child takes medicines and attends counseling appointments as directed, even if he or she feels better. A common cause of relapse is stopping treatment too soon.
It's very important to recognize the warning signs of suicide in your child or teen. Carefully watch for signs of suicidal behavior if your child has recently:
It is extremely important that you take all threats of suicide seriously and seek immediate treatment for your child or teenager. If you are a child or teen and have these feelings, talk with your parents, an adult friend, or your doctor right away to get some help. If your child is suicidal, call 911 or other emergency services immediately.
Several things increase a young person's chance of developing depression. These include:
Other risk factors for depression include:
Call 911, the national suicide hotline at 1-800-273-TALK (1-800-273-8255), or other emergency services right away if:
Call a doctor right away if:
Seek care soon if:
Treatment for depression may involve professional counseling, medicines, education about depression for your child and your family, or a combination of these. It is important that your child establish a long-term and comfortable relationship with the care providers for the treatment of depression.
Your child may be diagnosed and treated by more than one health professional, including a:
Professional counseling (or psychotherapy) for depression can be provided by a:
Other health professionals who also may be trained in counseling include a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor or another health professional will evaluate and diagnose depression in your child by asking questions about your child's medical history and conducting tests to find out if symptoms are caused by something other than depression. Your child may be given a physical exam or blood tests to rule out conditions such as hypothyroidism and anemia. Your child may be asked to complete a mental health assessment, which tests his or her ability to think, reason, and remember.
You may be asked to help complete a pediatric symptom checklist, a brief screening questionnaire that helps to diagnose depression or other psychological problems in children. Also, your child may be asked to take a short written or verbal test for depression.
Sometimes a more thorough evaluation may be needed to fully assess your child's depression. Interviews may be conducted with the parents or with other people who know the young person well. Specific information may be obtained from the child's teachers or from social service workers.
The U.S. Preventive Services Task Force recommends screening for depression in all children ages 12 to 18.5
The sooner treatment begins for depression, the sooner your child is likely to recover. Waiting to seek treatment for depression may mean a longer and more difficult recovery.
Treatment typically includes professional counseling, medicines, and education about depression for your child and your family.
Home treatment is an important part of treating depression. It includes regular exercise, healthy eating, and getting enough sleep.
Professional counseling for depression includes several types of therapy, such as cognitive-behavioral therapy and family therapy. For more information about counseling, see Other Treatment.
Medicines used to treat childhood depression include several types of drugs called antidepressants.
An important part of treatment is making sure that your child takes medicines as prescribed. Often people who feel better after taking an antidepressant for a period of time may feel like they are "cured" and no longer need treatment. But when medicine is stopped too early, symptoms usually return. So it is important that your child follows the treatment plan.
The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. Talk to your doctor about these possible side effects and the warning signs of suicide
Before prescribing medicine, your doctor will check your child for possible suicidal thoughts by asking a few questions. See a list of questions your doctor may ask your child.
Education of your child and family members can be provided by a doctor either informally or in family therapy. Some of the most important things that your child and family members can learn include:
Your child may need treatment for other disorders that may be causing ongoing symptoms, such as:
A brief hospital stay may be needed, especially if your child:
If your child is depressed, consider removing all guns and potentially fatal medicines from your home, especially if your child has shown any warning signs of suicide. Although overdosing on medicine is the most common way that teens attempt suicide, your child is at higher risk for dying by suicide if you have a gun in your home, particularly if it is easy to get to it or if you store it loaded.6
It is difficult to prevent a first episode of depression. But it may be possible to prevent or reduce the severity of future episodes of depression (relapses).
Do everything possible to provide a supportive family environment. Love, understanding, and regular communication are some of the most important things you can provide to help your child cope with depression.
In addition to having a positive home life, staying in professional counseling, and taking medicines as prescribed, good lifestyle habits can help reduce your child's symptoms of depression. Encourage your child to:
If you notice any warning signs of suicide (such as aggressive or hostile behavior, excessive thoughts about death, or detachment from reality), seek professional help immediately by calling either your child's doctor, a professional counselor, or a local mental health or emergency service. Call 911 if you feel your child is in immediate danger.
Although experts believe that, for many children with depression, the benefits of medicine outweigh the risks, research on antidepressant medicine in children is limited. The long-term effects and safety of medicines used to treat depression in children and teens are still unknown.
You may have heard about concerns regarding a possible connection between antidepressant medicines and suicidal behavior. The U.S. Food and Drug Administration (FDA) has issued advisories about this issue.
Especially during the first few weeks of treatment with an antidepressant, there is a possible increase in suicidal feelings or behavior. A child beginning antidepressant treatment should be watched closely. But children with untreated depression are also at an increased risk for suicide. So it is important to carefully weigh all of the risks and benefits of antidepressant medicine.
Medicine choices include:
Antidepressant medicines such as fluoxetine (Prozac, for example) can be effective in treating depression, but it may take 1 to 3 weeks before your child starts to feel better. It can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressant medicines as prescribed and keeps taking them so they have time to work. If you have any questions or concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child's doctor.
SSRIs may also be effective in treating other conditions such as anxiety.
Your child may have to try several medicines or different dosages before the most effective treatment is discovered. After the right medicine and dosage is found, your child may need to continue taking the medicine for several months or longer after the symptoms of depression have subsided, to prevent depression from occurring again.
Some children who are first diagnosed with depression are later diagnosed with bipolar disorder, which has symptoms that cycle from depression to mania (very high energy, often with euphoria, agitation, irritability, risk-taking behavior, or impulsiveness). If your child or teen has bipolar disorder, a first episode of mania can happen spontaneously. But it can also be triggered by certain medicines such as stimulants or antidepressants. That is why it is very important to tell your child's doctor about any family history of bipolar disorder and to watch your child closely for signs of manic behavior. For more information about bipolar disorder in young people, see the topic Bipolar Disorder in Children and Teens.
The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. These signs may include talking about death or suicide and giving away belongings. This is especially important at the beginning of treatment or when doses are changed.
Besides taking medicine, other treatment for depression includes professional counseling and electroconvulsive therapy.
Complementary medicines such as St. John's wort have been used to treat depression in adults. But there is no evidence that these therapies are safe for use by children or teens.2 They can also interfere with other medicines, such as antidepressants.
The U.S. Food and Drug Administration (FDA) has approved the vagus nerve stimulator (VNS) implant for treatment of depression in adults. This device may be used when other treatments for depression have not worked.
A generator the size of a pocket watch is placed in the chest. Wires go up the neck from the generator to the vagus nerve. The generator sends tiny electric shocks through the vagus nerve to that part of the brain that is believed to play a role in mood.
More study is needed to see how well this works in children who have depression.
This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more.
CitationsWagner KD, Brent DA (2009). Depressive disorders and suicide. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3652–3663. Philadelphia: Lippincott Williams and Wilkins.Hazell P (2011). Depression in children and adolescents, search date July 2011. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.Substance Abuse and Mental Health Services Administration (2009). Major depressive episode and treatment among adolescents. National Survey on Drug Use and Health (NSDUH) Report. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available online: http://oas.samhsa.gov/2k9/youthDepression/MDEandTXTforADOL.htm.Vanderbilt D, Augustyn M (2011). Bullying and school violence. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., online chap. 36.1. Philadelphia: Saunders Elsevier. Available online: http://www.expertconsult.com.U.S. Preventive Services Task Force (2009). Screening for Major Depressive Disorder in Children and Adolescents: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf09/depression/chdeprrs.htm.Dulcan MK, et al. (2012). Special clinical circumstances. In Concise Guide to Child and Adolescent Psychiatry, 4th ed., pp. 209–254. Washington, DC: American Psychiatric Publishing.Garber J, et al. (2009). Prevention of depression in at-risk adolescents: A randomized controlled trial. JAMA, 301(21): 2215–2224.Other Works ConsultedAmerican Psychiatric Association (2000). Seasonal pattern section of Mood disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 425–427. Washington, DC: American Psychiatric Association. Ascherman LI, et al. (2006). Mental development and behavioral disorders. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1213–1219. Philadelphia: W.B. Saunders.Baloch HA, Soares JC (2010). Mood disorders. In EG Nabel, ed., ACP Medicine, section 13, chap. 2. Hamilton, ON: BC Decker.Birmaher B, Brent DA, et al. (2000). Clinical outcomes after short-term psychotherapy for adolescents with major depressive disorder. Archives of General Psychiatry, 57(1): 29–36.Brent DA, Wheersing VR (2007). Depressive disorders. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 503–513. Philadelphia: Lippincott Williams and Wilkins.Klein DN, et al. (2001). A family study of major depressive disorder in a community sample of adolescents. Archives of General Psychiatry, 58(1): 13–20.March JS, et al. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) Randomized Controlled Trial. JAMA, 292(7): 807–820.Mrazek DA, Mrazek PJ (2007). Prevention of depression and suicide in children and adolescents. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 171–177. Philadelphia: Lippincott Williams and Wilkins.Sass AE, Kaplan CW (2012). Adolescence. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 113–152. New York: McGraw-Hill.Wagner KD, Brent DA (2009). Depressive disorders and suicide. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3652–3663. Philadelphia: Lippincott Williams and Wilkins.
Current as of: May 3, 2013
Author: Healthwise Staff
Medical Review: John Pope, MD - Pediatrics & David A. Axelson, MD - Child and Adolescent Psychiatry
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