Depression Resource Center

Depression has no single cause. Both genetics and the environment play a role. Depression in children and adolescents can be triggered by a medical illness, a stressful situation, family conflict, or a significant loss or disappointment. Young people with behavior problems or anxiety are more likely to get depressed. Sometimes, it can be hard to identify a specific triggering event.

Common symptoms of depression in children and adolescents include:

• Feeling or appearing depressed, sad, tearful, or irritable
• Not enjoying things as much as they used to
• Spending less time with friends or in after school activities
• Changes in appetite and/or weight
• Sleeping more or less than usual
• Feeling tired or having less energy
• Feeling like everything is their fault or they are not good at anything
• Having more trouble concentrating
• Caring less about school or not doing as well in school
• Having thoughts of suicide or wanting to die

Children may also have more physical complaints, such as frequent headaches or stomach aches. Depressed adolescents may use alcohol or other drugs as a way of trying to feel better.

It can be hard to know for sure if a child or adolescent is depressed. Not every child or adolescent displays all of the symptoms of depression listed above. Talking to your children - and making sure that they can always talk to you - increases the chance of learning if and when your child is depressed. Share your concerns with your child and let them know you care about how they feel.

Many pediatricians screen for depression at annual well-child exams. They may use one of the tools listed in the "Clinical Resources" section of this Resource Center. If you have concerns about depression, talk to your child's doctor, who can do an initial evaluation, and if necessary, make a referral for treatment.

Depression may improve, over time, but if left untreated, it can be very serious with potential lasting consequences. When depressed, children and adolescents may lose friends and fall behind at school. Depressed children and adolescents are more likely to try drugs or get into trouble. Untreated depression can also lead to thoughts about suicide. It is also important to note that once someone has an episode of depression, they are more likely to get depressed in the future.

The good news is that there are several effective treatments for depression. Treatment may include psychotherapy (or "talk therapy"), meetings with your family, and, with your permission, discussions with your child's school. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of psychotherapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. Before starting treatment, a doctor will discuss its risks and benefits, as well as how treatment will be monitored.

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.

When prescribed and monitored carefully, medication can be a safe and appropriate intervention for children and adolescents with depression. However, medication is most effective when used as a component of a comprehensive treatment plan, individualized to the needs of the child and family.

Suicide is a serious and growing problem among children and adolescents. Each year, thousands of young people die by suicide. Suicide is the second leading cause of death for 10-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds.

The majority of children and adolescents who attempt suicide have a significant mental health disorder, usually depression.

Among younger children, suicide attempts are often impulsive. They may be associated with feelings of sadness, confusion, and anger. Among teenagers, suicide attempts may be associated with feelings of stress, self-doubt, pressure to succeed, financial uncertainty, disappointment, and loss. For some teens, suicide may appear to be a solution to their problems.

Parents, teachers, and friends should always err on the side of caution and safety. Any child or adolescent with suicidal thoughts or plans should be evaluated immediately by a trained and qualified mental health professional.