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Depression in children and young people

Published by Bupa's health information team, May 2009.

This factsheet is for parents who have a child who is depressed or who would like to know more about depression in children.

Depression is a condition characterised by a low mood, a loss of interest in everyday activities, feelings of low self-worth, a lack of energy and poor concentration, all of which are prolonged.

About depression
Symptoms of depression
Complications of depression
Causes of depression
Diagnosis of depression
Treatment of depression
Questions and answers
Related topics
Further information
Sources

About depression

Around two in every 100 children under 12 are affected by depression. Among teenagers this rises to five in every 100.

All children feel sad or miserable from time to time but these feelings often pass. Children are said to be depressed if they feel sad for two weeks or longer. Depression can make your child feel sad or low for a long period of time and it can interfere with his or her life. Your child may find everything harder to do and in severe cases he or she may even have suicidal thoughts. There are three types of depression.

Mild depression

Mild depression makes your child feel unhappy, but doesn't stop him or her from leading a normal life. Your child may find everyday things difficult to do and less worthwhile. Simple lifestyle changes can help your child recover from mild depression.

Moderate depression

Moderate depression has a significant impact on your child's life. It can make him or her feel constantly miserable and low. Your child should visit his or her GP as changes in lifestyle alone are unlikely to help.

Severe depression

If your child feels like he or she isn't able to cope and has constant negative thoughts, he or she may have severe depression. This is a life-threatening illness as it could make your child suicidal, so it's important that he or she visits a doctor immediately.

Symptoms of depression

The symptoms of depression can vary from person to person. It can sometimes be difficult to tell if a young person is showing signs of normal adolescent development or symptoms of depression. Some of the most common symptoms include:

feeling hopeless or helpless
crying a lot
feeling unhappy for most of the day
lack of self-esteem and not wanting to see friends or family
problems sleeping
tiredness and lack of energy
difficulty concentrating
loss of confidence
changes in eating pattern
aches and pains for no reason
thoughts about death or suicide

The type and number of symptoms that your child has will depend on whether he or she has mild or severe depression. If your child has some of the above symptoms and you're worried that he or she has depression, you should talk to his or her GP.

Complications of depression

Around one in ten children with depression recovers on their own within three months. After one year, half of all children with depression get better. In severe cases depression is associated with self-harm and suicide so it's important that you look out for changes in your child's mood.

Causes of depression

Depression in children and young people is normally caused by a number of factors including:

family problems or parents splitting up
death of a relative, friend or someone close
bullying
neglect
long-term health problems or serious illness
school problems
major life change such as moving house
friendship problems
alcohol or substance misuse

Depression is thought to run in families and a child with a close relative who has depression is more likely to get depression themselves. It's more common in girls than boys, but teenage suicide rates are higher in boys than girls.

Depression is also linked to changes in how your child's brain works. Chemical changes are thought to occur in the part of your child's brain that controls mood and causes symptoms of depression.

Diagnosis of depression

If you think your child is depressed, it's important that you seek medical help early. Your child's GP is a good first point of contact. He or she may suggest your child completes a number of psychological and medical tests to see if any other medical condition is causing his or her symptoms.

Many young people get better on their own, but if your child's depression is severe, your GP may refer him or her to a local child and adolescent mental health service. Your child may need to see a psychiatrist, a doctor who specialises in mental health problems. He or she may also be referred to a clinical psychologist who can talk with your child about his or her problems.

Treatment of depression

Almost one in three children or young people who have an episode of depression will have at least one more episode within the next five years. However, most children and young people who have an episode of depression will go on to lead a normal adult life.

A number of treatments are available for depression. The type of treatment your child has will depend on the severity of his or her depression.

Self-help

If your child has mild depression, there are a number of things he or she can do to help with recovery. Regular exercise, such as walking, running, swimming or cycling can help your child feel better. Your child's doctor may advise him or her to follow an exercise programme. It's important that your child eats a healthy balanced diet. Providing support to your child is also very important. You could try talking to your child about his or her problems and giving reassurance that you will help him or her get better.

Medicines

Antidepressant medication is only offered to children and young people if the child has severe depression or if the symptoms persist. If your child is advised by his or her doctor to take medication, he or she will usually be offered an antidepressant called fluoxetine (Prozac) in addition to therapy. Your child will be monitored weekly for the initial four weeks and then regularly after. Your child's doctor will give him or her information about any possible side-effects and how long the treatment should last. Always read the patient information leaflet that comes with the medicine.

If your child doesn't feel better after taking fluoxetine, or in rare cases, such as if your child has suicidal thoughts or has lost a lot of weight, he or she may be offered a different antidepressant such as sertraline or citalopram. Other antidepressant drugs such as paroxetine and venlafaxine shouldn't be used as they may have bad side-effects.

Your child will need to take antidepressant medication for six months after he or she feels better to make sure he or she recovers.

Hospital treatment

Most children and young people who have depression can be successfully treated without being admitted to hospital. However, if your child has suicidal thoughts or his or her doctor is worried about self-harm, he or she may need the shelter and protection of a hospital. If your child's doctor believes this is the best decision, he or she will give you and your child more information and advice.

Talking therapies

Counselling involves your child talking to a therapist about his or her problems. In these sessions the counsellor won't offer advice or treatment but will ask your child questions to help resolve his or her worries. Counsellors can sometimes work with you and your child's school.

Cognitive behavioural therapy (CBT) can help your child change his or her behaviour and negative thoughts and feelings that may have developed since he or she became depressed. Depending on the severity of your child's depression, CBT can be performed in a group with other people the same age or individually. For more information about CBT, please see Related Topics.

Interpersonal therapy involves your child talking with a therapist about any relationship problems he or she may have with friends, family or people at school. The therapist will help your child solve or manage his or her problems.

Family therapy is a type of treatment that involves you and your child. You will meet with a therapist and your child will talk about any problems he or she is having. The therapist may offer you help to deal with your problems. The type of talking therapy your child has will depend on what's available, his or her preferences and how severe the depression is.

Complementary therapies

St John's wort is often used by adults as an alternative to antidepressants. Children shouldn't use St John's wort for the treatment of depression as the safety of the herbal remedy is unknown in children.