What causes depression in children?

Depression has no single cause. Both genetics and the environment play a role, and some children may be more likely to become depressed. Depression in children can be triggered by a medical illness, a stressful situation, or the loss of an important person. Children with behavior problems or anxiety also are more likely to get depressed. Sometimes, it can be hard to identify any triggering event.

What are the signs and symptoms of depression?

Common symptoms of depression in children and adolescents include those listed below. In “major depression,” five or more of these symptoms last for over two weeks, and cause difficulty in everyday life. In a less severe but longer lasting condition called “dysthymia,” two or more of these symptoms are present, more often than not, for a year.

  • Feeling or appearing depressed, sad, tearful or irritable
  • Decreased interest in or pleasure from activities, which may lead to withdrawal from friends or after-school activities
  • Change in appetite, with associated weight
  • Major changes in sleeping patterns, such as sleeping much more or less than normal
  • Appearing to be physically sped up or slowed down
  • Increase in tiredness and fatigue, or decrease in energy
  • Feeling worthless or guilty
  • Difficulty thinking or concentrating, which may correlated with worsening school performance
  • Thoughts or expressions of suicide or self destructive behavior

In children it is important to keep in mind that an increase in irritability or even complaints of boredom may be more noticeable than sadness. Children also may have more physical complaints, particularly if the child does not have the habit of talking about how he or she feels. Talk of suicide or not wanting to be alive can be difficult to interpret, so it must be take seriously and brought immediately to a doctors attention. 

Will depression improve without treatment?

Different types of depression have different patterns of improvement. Dysthymia tends to be less severe but longer lasting. Major depression may improve by itself, but if left untreated, it can be very severe. When they are depressed, children may lose friends and family members, and fall behind at school. Depressed children are more likely to try drugs or get into other trouble. What’s worse, untreated depression can progress lead youth to think about suicide. It is also important to note that, once someone has one episode of depression, they are more likely to get depressed in the future.

What should treatment consist of?

When possible, treatment for depression childhood depression should include both psychotherapy and medication. In milder forms of depression, it is reasonable to start with a psychotherapy, but treatment with a medication and psychotherapy should be considered for moderate to severe forms of major depression. Before starting treatment, a doctor will discuss it’s risks and benefits, as well as how the treatment should be monitored.

Does psychotherapy work? How?

Several types of therapy can be used to help depressed children. Below are some examples of how they work.

  • Individual Therapy - Several types of therapy have been proven to be effective in depressed youth. The individual therapies with the most evidence are Cognitive Behavior Therapy (CBT) and Interpersonal Therapy (IPT).

    CBT helps improve a child's mood, by changing unhealthy patterns of thinking. CBT therapists teach children that thoughts cause feelings and moods which can affect behavior. During CBT, a child learns to “see” harmful thought patterns. The therapist then helps the child replace this thinking with thoughts that result in better feelings and behaviors.

    IPT helps improve mood by improving interpersonal relationships. IPT therapists help depressed children identify “interpersonal events,” and how these events affect their relationships, their moods and their lives. Through exercises such as talking and role play, problem relationships are more fully understood and addressed.
  • Family Therapy focuses on helping the family function in more positive and constructive ways by looking at patterns of communication and providing support and education. Sometimes family therapy uses CBT and IPT principles described above. Family therapy sessions can include the child or adolescent along with parents, siblings, and grandparents.
  • Group Therapy is a form of psychotherapy where there are multiple patients led by one or more therapists. It uses the power of education and how people interact in a group to improve our understanding of and recovery from depression 
Are medications safe? Do they increase risk of suicide?

When prescribed and monitored carefully, medications are both safe and effective ways to treat of depressed youth. Fluoxetine or Prozac, a selective serotonin reuptake inhibitor, is the medicine that so far has proved most safe and effective. There are times, however, when other medications can and should be used.

While medications have been associated with a small increase in thoughts of suicide, there is no evidence that antidepressants actually increase the risk of suicide. For moderate to severe depression, the potential benefits from medication treatment seem to outweigh the potential risks. Click here for a complete discussion of the use of medication in childhood depression.