Depression in Children and Teens

Cause

What causes depression in children and teens is not well understood. It's thought to be caused by an imbalance of chemicals called neurotransmitters that send messages between nerve cells in the 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 found why neurotransmitters get out of balance. They believe a change can occur in response to stress or illness. But a change may also occur with no obvious trigger.

What Increases Your Risk

The most important risk factor for depression is having a parent who is depressed. Other things include stressful events, drug or alcohol problems, and long-term health problems.

Symptoms

The symptoms of depression are often hard to notice 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.

Physical symptoms

Physical symptoms in children and teens may include:

• Unexplained aches and pains, such as headaches or stomach pain.
• Trouble sleeping or sleeping too much.
• Changes in eating habits that lead to weight gain or loss or not making expected weight gains.
• Always feeling tired or having no energy.
• Body movements that seem slow, restless, or agitated.

Mental or emotional symptoms

These symptoms may include:

• Irritability or temper tantrums.
• Difficulty thinking and making decisions.
• Having low self-esteem, being self-critical, and/or feeling that others are unfairly critical.
• Feeling guilty or hopeless.
• Socially withdrawing, such as lacking interest in friends.
• Having anxiety, such as worrying too much or fearing separation from a parent.
• Thinking about death or feeling suicidal.

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 always talking or thinking about death or suicide or a recent breakup of a relationship. Create a plan to help keep your child safe. Lock away knives and other sharp objects, firearms, poisons, and medications. Get help for your child right away.

Less common symptoms

Children who have severe depression may also have other symptoms, such as:

• Hearing voices that aren't there (hallucinations).
• Having false but firmly held beliefs (delusions).

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When to Call a Doctor

Call 911 or other emergency services immediately if:

• Your child is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
  • Deciding how to kill themself, such as with a weapon or pills.
  • Setting a time, place, and means to do it.
  • Thinking there is no other way to solve the problem or end the pain.
• Your child feels that they can't stop from hurting themself or someone else.

If your child talks about suicide, self-harm, or feeling hopeless, get help right away. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or text HOME to 741741 to access the Crisis Text Line. Consider saving these numbers in your phone.

Call a doctor now if:

• Your child hears voices.
• Your child has been thinking about death or suicide a lot but doesn't have a suicide plan.
• Your child is worried a lot that the feelings of depression or thoughts of suicide aren't going away.

Seek care soon if:

• Your child has symptoms of depression, such as:
  • Feeling sad or hopeless, or being irritable.
  • Not enjoying anything.
  • Often complaining of stomachaches or headaches.
  • Having trouble with sleep.
  • Feeling guilty.
  • Feeling anxious or worried.
• Your child has been treated for depression for more than 3 weeks but is not getting better.

Check your symptoms

Exams and Tests

A doctor may do a physical exam and ask questions about your child's past health. The doctor may ask your child about their feelings, changes in eating habits, energy level, and interest in daily tasks. The doctor may also ask how well your child is sleeping and how well they can focus on tasks. This may be a talk between the doctor and your child, or your child may fill out a form. The doctor may also ask you questions.

The doctor may also ask questions about other problems. Children with depression often have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. Finding other problems can help your child get the right diagnosis and treatment.

Some diseases can cause symptoms that look like depression. So your child may have tests to help rule out physical problems, such as a low thyroid level or anemia.

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Treatment Overview

Treatment usually includes education about depression, professional counseling, and medicine. A child with severe depression may need to be treated in the hospital.

Education

Education about depression can be provided by a doctor or in family therapy. Some important things for you and your child to learn include how to:

• Be sure your child is following a treatment plan. This often includes taking medicine correctly and going to counseling appointments.
• Know the signs of a relapse. Learn what to do to prevent depression from returning.
• Know the signs of suicidal behavior, how serious they are, and how to respond. Your child and your child's doctor may develop a plan to keep your child safe if your child shows signs of self-harm.
• Identify signs of a manic episode. This is a bout of extremely high mood and energy or irritability. It's a sign of bipolar disorder.
• Seek treatment if you are a parent with depression. If you have depression that isn't treated, it may be harder for your child to recover.

Counseling

Several types of counseling can be used to treat depression. They may include:

• Cognitive behavioral therapy. It can help children and teens change negative thoughts that make them feel bad.
• Interpersonal therapy. It focuses on helping teens with relationships. It helps them find solutions for problems that are bothering them.

It's important to find a mental health professional you and your child trust and feel comfortable with. Together you will develop an action plan to treat your child's depression.

Medicine

Antidepressant medicine may be an option if a child is very depressed. Combining antidepressant treatment with counseling often works best.

There are several types of antidepressants. Some common ones include:

• Escitalopram (such as Lexapro).
• Fluoxetine (such as Prozac).
• Sertraline (such as Zoloft).

Before prescribing an antidepressant, your doctor will ask your child some questions to check for suicidal thoughts. 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.

Make sure that your child takes the medicine as prescribed. After taking an antidepressant for a while, people often feel like they are "cured." They may think they no longer need treatment. But when medicine is stopped too early, symptoms usually return.

Other treatment

In some cases, the doctor may recommend electroconvulsive therapy for an older child or a teen who has severe depression or doesn't respond to other treatment.

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Caring for Your Child

• Offer your child support and understanding. This is one of the most important things you can do to help your child cope with being depressed.
• Be safe with medicines. Have your child take medicines exactly as prescribed. Call your doctor if your child has any problems with a medicine. It is important for your child to keep taking medicine for depression even after symptoms go away, so that it does not come back. Your child may need to try several medicines before finding the one that works best. Many side effects of the medicines go away after a while. Talk to your doctor about any side effects or other concerns.
• Make sure your child gets enough sleep. There are things you can do if your child has problems sleeping. For example, have your child go to bed at the same time every night and get up at the same time every morning. Keep the bedroom dark and free of noise.
• Make sure your child gets regular exercise, such as swimming, walking, or playing vigorously every day.
• Avoid over-the-counter medicines, herbal therapies, and any medicines that have not been prescribed by your doctor. They may interfere with the medicine used to treat depression.
• Give your child healthy foods. If your child doesn't want to eat, try offering small, frequent snacks rather than 1 or 2 large meals each day.
• Encourage your child to be hopeful about feeling better. Positive thinking is very important in treating depression. It's hard to be hopeful when you feel depressed, but remind your child that recovery happens over time.
• Find a counselor your child likes and trusts. Encourage your child to talk openly and honestly about any problems.
• Work with your child's doctor to create a safety plan. A plan covers warning signs of self-harm, coping strategies, and trusted family, friends, and professionals your teen can reach out to if they have thoughts about hurting themselves.
• If your child talks about suicide, self-harm, or feeling hopeless, get help right away. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or text HOME to 741741 to access the Crisis Text Line. Consider saving these numbers in your phone.

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