Depression

While each child may experience symptoms differently, some of the most common include:

• persistent feelings of sadness
• feeling hopeless or helpless
• having low self-esteem
• feeling inadequate
• excessive guilt
• loss of interest in usual activities or activities once enjoyed
• difficulty with relationships
• sleeping too much or too little
• changes in appetite or weight
• decreased energy
• difficulty concentrating
• trouble making decisions
• suicidal thoughts or attempts
• frequent physical complaints such as headaches, stomach aches, or fatigue
• running away or threats of running away from home
• hypersensitivity to failure or rejection
• irritability, hostility, aggression

While the exact cause of depression and other mood disorders is not known, they've been linked to genetics and environmental factors. The most common factors associated with depression include:

• family history of depression
• parents’ divorce
• excessive stress
• abuse or neglect
• trauma (physical and/or emotional)
• loss of a parent, caregiver, or other loved one
• loss of a relationship, such as moving away or loss of boyfriend/girlfriend
• failure to accomplish tasks such as learning to read, or keeping up with peers in other activities
• chronic illnesses, such as diabetes
• other psychiatric disorders
• other developmental, learning, or conduct disorders

There are biological, psychological, and social factors that can contribute to depression separately or in combination.

• Depression is thought to be caused by a difference in the structure and function of your child’s brain that controls the intensity of sad or irritable moods.
• There may be a genetic component. If other members of your family have had depression, your child is more likely to develop it, too.
• A stressful environment at home, school, or in the community can contribute to depression.
• Children may experience depression if they feels unhappy with their environment and powerless to make any change to it.

Low thyroid levels may sometimes cause fatigue, and other symptoms that may mimic symptoms of depression. Your child’s doctor can discuss this with you in more detail.

If you suspect your child is depressed, a mental health clinician (who may be a child/adolescent psychiatrist, child psychologist, or a social worker who specializes in child and adolescent mental health) will ask you and your child to come in for a visit. The clinician will ask about your child’s:

• symptoms
• social history
• medical history
• academic history
• family history

It can sometimes be hard to distinguish between sadness and grief and major depression. In order to correctly diagnose your child with depression, doctors use a standardized set of two types of symptoms that must be present.

Core symptoms

• persistent sadness
• persistent loss of interest in almost all activities

Associated symptoms

• loss of energy
• loss of appetite (or increase)
• changes in sleeping patterns
• agitation or irritability
• feelings of worthlessness or excessive guilt
• indecisiveness
• wanting to die

Depression is when one or both of the core symptoms persist for at least two weeks along with five of the associated symptoms. If the symptoms are due to substance abuse, a medical illness, or grief over a recent loss, they are usually not signs of depression.

When children have some symptoms, but not enough to indicate depression, they may have dysthemia.

Therapy

Talking with a therapist can help your child learn to manage sad feelings by developing new strategies. These include learning how to:

• identify and talk about feelings
• stop thinking automatically negative thoughts
• find activities that are soothing and comforting
• discover and appreciate good things about himself
• build hope for the future

Therapy can also help your child:

• work through difficult relationships and situations
• identify stressors in and figure out how to avoid or handle them
• improve his view of her environment

As with any treatment, parents and teachers play a vital and supportive role.

Medication

If your child's depression does not improve with therapy, or the depression is very severe, the doctor may prescribe antidepressants. These not only help your child feel better, but also help with motivation and coping skills in therapy.

Unfortunately, no single medication is effective in all children, and a trial-and-error period may last for weeks, or even months, as doctors find the best treatment for your child. When considering medication as a treatment option, the clinician will take into account:

• how well the drug has treats the symptoms your child has
• family history
• side effects of the drug
• how easy it will be to take the medication as prescribed

It's important to remember — and for your child to remember — that in order to have a chance for it to work, medication must be taken as prescribed.

Learn about psychiatric medications for children and adolescents.

Environment

While not a treatment in the strictest sense of the word, paying attention to your child's environment can also help treat depression. If a situation at home could be contributing to depression, family therapy may be helpful. If other circumstances are triggering the sad feelings, and it is at all possible to change them, doing so will increase the chance of successful treatment.

If your child is diagnosed with a mental health condition in addition to depression, such as anxiety, treatment must address both conditions. If your child's depression is particularly severe, debilitating, or self-endangering, hospitalization may be required.

The Boston Children’s Hospital Department of Psychiatry and Behavioral Sciences has long been at the forefront of providing expert, compassionate care to children and adolescents with mental health issues. Our approach to mental health care is evidence-based — which means our treatments have been tested and proven effective through scientific studies, both here at our hospital and by other leading institutions worldwide. Boston Children’s has a dedicated Psychopharmacology Clinic to help determine whether medication might be a helpful addition to the treatment plan.

For children's that need hospitalization, Boston Children's Inpatient Psychiatry Service provides family oriented psychiatric assessment and treatment with the goal of returning your child to a more comfortable environment for ongoing care.

The majority of children respond to treatment for depression, so it’s most likely that your child will, too. The time frame depends on many factors. A child who is good at communicating may benefit from talk therapy (our primary method of treatment) more quickly than a child who is more hesitant. If your child is taking medication, it may take a while to find the ones that work best.

Dysthemic disorder, or “dysthemia,” is a milder form of depression. If your child has dysthemia, he or she will be in a depressed or irritable for most of the day, more days than not, for at least a year. They may not seem as depressed as a child with major depression but still not function or feel well.

To be diagnosed with dysthemia, your child must show impaired functioning at home, school and also with friends. Children with dysthemia may experience a bout of major depression.

It's estimated that around four out of 100 children and teens have dysthemia, and it' s equally common in boys and girls. Children with dysthemia are more likely to develop major depression as teenagers or young adults.

The safety and efficacy of antidepressants for children and teens have been studied extensively. Prozac and other medications known as selective serotonin reuptake inhibitors (SSRIs) have been shown to be safe in most studies and can be effective for teenagers, but should be carefully monitored by the prescribing physician.

Since 2004, the U.S. Food and Drug Administration has placed a black warning label on antidepressant medications, warning that antidepressants can increase the risk of suicidal thinking and behavior in children and adolescents with major depression and other psychiatric disorders. If your child is prescribed antidepressants, your clinician will carefully go over the specifics of the drug, as well as any potential side effects you should watch for.

If you think your child is depressed, it’s important to have an evaluation as soon as possible. Contact your child’s pediatrician, who may refer you to a mental health professional. If you’re concerned your child might harm themself or others, call your child’s mental health practitioner or primary care doctor immediately. It’s very important you take any suicidal signs seriously.