Depression in Children and Teens

Cause

The cause of depression in children and teens is not well understood. There are many factors that may be involved. It tends to run in families. And if something stressful or traumatic happens to a child or teen, they may be more likely to get depression.

Depression is a complicated condition. Children and teens with depression may have different causes of depression, even if their symptoms are the same.

What Increases Your Risk

Children or teens may be more likely to have depression if someone in their family has had it. They may also be at a higher risk after experiencing stressful or traumatic events, such as being bullied. Other things that increase the risk of depression include having other mental health conditions or experiencing abuse.

Symptoms

There are many symptoms of depression that you can watch for in your child. These symptoms occur nearly every day, and they last at least 2 weeks.

Symptoms of depression in children and teens may include:

• Feeling sad, empty, or hopeless.
• Being in an irritable mood much of the time.
• Losing interest in activities they usually enjoy.
• 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.
• Difficulty thinking and making decisions.
• Feelings of guilt.
• 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.

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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.

Where to get help 24 hours a day, 7 days a week

If your child talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call the Suicide and Crisis Lifeline at 988.
• Call 1-800-273-TALK (1-800-273-8255).
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

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.
  • Having trouble with sleep.
  • Feeling guilty.
• 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. If your child's symptoms are mild to moderate, counseling or lifestyle changes may be enough to help your child feel better. But if your child's symptoms don't improve with counseling, your child's doctor may recommend that medicine be added. If your child's symptoms are severe, a combination of antidepressants and counseling may work better than if only one of these treatments is used.

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:

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 may work best. But what works best may depend on the age of your child.

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

• Fluoxetine.
• Escitalopram.
• Sertraline.

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.

The safety and long-term effects of medicines used to treat depression in children and teens are not fully known. Talk to your child's doctor about the risks and benefits of these medicines. Together you can decide if medicine is right for your child.

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.

Where to get help 24 hours a day, 7 days a week

If your child talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call the Suicide and Crisis Lifeline at 988.
• Call 1-800-273-TALK (1-800-273-8255).
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Learn more