Although most people think of depression as an adult illness, children and adolescents can develop depression as well. Unfortunately, many children with depression go untreated because adults don't recognize they're depressed.
It's important for parents, teachers, and other adults to learn about childhood depression. When you understand the symptoms of depression in children and the reasons children develop it, you can intervene in a helpful manner.
Depression in children and teens often presents differently than it does in adults. Irritability and/or anger are more common signs of depression in children and teens. Additionally, young children often find it difficult to explain how they’re feeling, while teens may attempt to hide their emotional pain fearing judgment from others.
Because normal behaviors vary as children develop, it can be challenging to know if your child is going through a phase or if it’s something more serious. The first step towards helping your child battle depression is learning how to spot it.
According to the American Academy of Child and Adolescent Psychiatry, common signs of depression in children and teens last longer than two weeks and include:
- Changes in appetite or weight
- Feeling or appearing depressed, sad, tearful, or irritable
- Fatigue or perceived lack of energy
- Feeling guilty or ashamed
- Having more trouble concentrating
- Loss of interest or pleasure in previously enjoyed activities
- Psychomotor slowing or agitation
- Recurrent thoughts of suicide and/or death
- Sleep disturbance: Insomnia or hypersomnia nearly every day
In addition to the above symptoms, some children have physical complaints, such as stomachaches and headaches, substance use, and poor school performance.
Children are often less likely to meet the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria for depression. As they age, symptom presentation becomes more consistent with the DSM-5 criteria.
While stressful life events, like divorce, may contribute to depression, it's only a small piece of the puzzle. Many other factors, including genetics, also play a role in its development.
There are a number of different factors that can contribute to childhood depression including:
- Brain chemistry : Imbalances in certain neurotransmitters and hormones may play a role in how the brain works, which can affect moods and emotions and increase the risk of experiencing depression.
- Environmental factors : A stressful, chaotic, or unstable home environment can also make children more likely to experience depression. Rejection and bullying at school may also be a contributing factor.
- Family history : Children with family members who also have mood disorders such as depression are at a greater risk for also experiencing symptoms of depressive disorders.
- Stress or trauma : Sudden changes such as moving or divorce, or traumatic events such as abuse or assault can also contribute to feelings of depression.
Anyone can develop depression, and it isn't a sign of weakness. It also isn't your fault if your child is depressed.
If you think your child is showing signs of depression, schedule an appointment with your child's pediatrician to discuss your concerns.
Before arriving at a diagnosis, your child will have to undergo a comprehensive physical and medical evaluation. Both will rule out any underlying medical conditions which could be contributing to the symptoms you are seeing. For example, thyroid problems, anemia, and vitamin deficiency can all mimic symptoms of depression.
While there is no specific test for depression, a doctor may use one or multiple psychological assessments to further evaluate the type and severity of depression your child is experiencing.
Classification of Depression
When your child is diagnosed with a depressive disorder, it is typically classified by severity:
According to the DSM-5, this classification is based on the number, type, and severity of symptoms and the degree to which they interfere with your day-to-day life.
If your child is diagnosed with mild depression, their doctor will actively monitor their symptoms before recommending any form of treatment. If their symptoms persist after 6 to 8 weeks of support, they will be referred for psychotherapy. If your child is initially diagnosed with moderate to severe depression, their doctor will likely skip this step and start treatment immediately.
Psychotherapy, medications, or a combination of the two have been shown to help young people with depression. The kind of treatment recommended for your child will depend on the nature and severity of their depression.
If your child is diagnosed with mild depression, the APA recommends psychotherapy as a first-line treatment. For adolescents with moderate to severe depression, research has shown that a combination of psychotherapy and medication works best.
In psychotherapy, a mental health professional will help your child develop the skills needed to manage their depressive symptoms so they can function well both at home and in school. Two kinds of psychotherapy are recognized as the treatment of choice for children with depression:
- Cognitive behavioral therapy (CBT) : Helps improve a child's mood by identifying negative thought and behavior patterns and replacing them with positive ones.
- Interpersonal therapy (IPT) : An approach in which therapists help adolescents learn how to handle relationship problems that may be contributing to or resulting from their depression.
The APA recommends that psychotherapy always be a component of treatment for childhood and adolescent depression.
Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line antidepressant option for young people with depression. Only two SSRIs— Prozac (fluoxetine) and Lexapro (escitalopram)—are FDA-approved for use in young people with depression.
Their doctor may also prescribe a different SSRI or a serotonin-norepinephrine reuptake inhibitor (SNRI) if they think it is in your child's best interest. This is referred to as off-label use, and it is fairly common practice.
Antidepressants and Suicidal Thinking
While antidepressants can be an effective way to treat childhood depression, their use has been linked to serious side effects , such as suicidal thinking in people under age 25. Though this side effect is rare, the Food and Drug Administration (FDA) now requires that all antidepressants carry a black box warning about this increased risk of suicide.
This does not mean that antidepressants should not be used by people in this age group. It simply means that they should be carefully monitored by doctors and caregivers, particularly in the first few weeks after starting an antidepressant.
For mild cases of depression, lifestyle changes can often be an effective way to address feelings of depression. Things like finding ways to manage stress, getting regular physical exercise, using relaxation techniques, and building a stronger social support system can help improve how a child feels.
The following are some proactive steps you can take to encourage healthy coping skills and support mental health:
- Talk about how caring for the body also helps the mind. Explain how eating nutritious food and getting plenty of exercise is good for their mental health .
- Make sure your child has a consistent sleep schedule. Turn off devices before bedtime, and make sure your child goes to bed and wakes up at the same time each day.
- Help your child develop a rich social life without over-scheduling their time. Assign responsibilities, and reward them for being responsible.
- Teach your child how to solve problems , manage their emotions in healthy ways, and develop strategies that will help them cope with failure and setbacks. Talk about your mental health too, and make staying healthy a priority in your family.
Ultimately, it's up to the guardians to decide what treatment options to employ. It's important for parents and children to educate themselves about treatment and the potential risks and benefits of each option.
A Word From Verywell
Childhood depression can have a serious impact on a child's life, so it is always important to be on the lookout for warning signs that your child may be depressed. Talk to your child about what they are feeling, and be careful to remain supportive and non-judgmental.
Thankfully, early interventions can help kids get back on track before symptoms of depression take a serious toll on their life and ability to function.
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