This leaflet is provided by the Royal College of Psychiatrists, the professional body responsible for education, training, setting and raising standards in psychiatry. They also provide readable, user-friendly and evidence-based information on various mental health problems.
What is depression?
Feeling sad or fed up is a normal reaction to experiences that are difficult or stressful. Sometimes these feelings of sadness can go on for some time and can start to interfere with everyday life. At these times the low moods become part of an illness we call ‘depression’.
How common is depression?
Depression is thought to occur in around 1-3% of children and young people. Anybody can have depression and it happens in people of all ages, races, income levels and educational levels. Teenage girls are twice as likely as teenage boys to be depressed.
What causes depression?
There is no specific cause for depression. It can be caused by a mixture of things, rather than any one thing alone. It may be triggered by stressful life events - for example, bullying at school, parental separation or divorce, bereavement or conflicts with family members or friends. It can also run in families, especially if a parent has depression or a mood disorder such as bipolar disorder (also called ‘manic depression’).
What are the symptoms of depression?
When a child or young person is depressed many changes can be seen. They may:
- Lose interest in activities that they enjoyed before.
- Lose their appetite or start overeating.
- Have problems with concentration, remembering things or making decisions.
- Self-harm or have thoughts of suicide.
- Have disturbed sleep or sleep far too much.
- Feel tired all the time, exhausted.
- Complain of aches and pains - for example, headaches or tummy pains.
- Have little self-confidence.
- Express feelings of guilt for no reason.
In children, especially teenagers, being irritable and grumpy all the time can also be a symptom of depression, not just of being in a ‘bad mood’.
At the extreme end of depression, some young people can develop ‘psychotic symptoms’ - they may start to have very unusual and sometimes unpleasant thoughts and experiences.
Some children also have periods of high mood (also called ‘mania’) along with periods of low mood. This may mean they have bipolar mood disorder.
What effects can depression have on the young person?
A child or young person with depression can have major problems in not only how they feel, but also how they behave. This may cause difficulties at home, at school, as well as with relationships with family and friends. Some young people may try to cope with their problems by engaging in risky behaviours, such as self-harming (eg, cutting), misusing drugs or alcohol, having inappropriate sexual relationships (leading to teen pregnancy in girls), dropping out of school, and, at the extreme end, suicide.
The longer the illness continues without understanding, help or treatment, the more harmful it is likely to be to the life of the young person and to their family.
Where can I get help?
Depression is a treatable illness. The first step towards getting help is to recognise that there might be a problem. It might help to talk to others who know your child. For instance, contact the school to find how they are doing.
If you suspect that a young person is depressed, seeking medical advice early on is very important. As a first step, you should contact your GP. If necessary, they can then make a referral to your local child and adolescent mental health service (CAMHS) which can offer more specialist help.
How is depression treated?
The goal of treatment is to improve the symptoms, prevent the illness from returning and help the young person lead a normal life. Families play an important role in recognising the illness, supporting the young person through treatment and also preventing the illness from coming back. It is therefore very important that you understand the condition.
Depending on how depression is affecting your child and how severe it is, they may need different treatments. When they have severe symptoms or have difficulties such as serious suicidal thoughts or other risky behaviours, they may need medication and sometimes admission to hospital.
Psychological (‘talking’) treatments and medication both may have an important role in the treatment of depression.
Talking treatments (also known as ‘psychotherapies’)
Psychological therapies such as cognitive behavioural therapy (CBT) or ‘interpersonal therapy’ may be tried before considering other possibilities such as medication. This will depend on the individual's illness and their personal circumstances.
Certain antidepressant medications, known as selective serotonin reuptake inhibitors (SSRIs), have been shown to be beneficial to children and adolescents with severe depression.
It is very important that once started, medication should not be stopped suddenly. It may be needed for months or even years. Some people may, under medical supervision, be able to stop their medication when they have recovered and have felt well for a while.
Before starting the treatment or while on medication, a young person may need physical examinations and tests (eg, blood tests). It is important that if the young person is prescribed medication, they are seen regularly by their doctor or psychiatrist.
There are side-effects to antidepressant medication, some of which can be quite serious. The psychiatrist will be able to advise you about what they are and what can be done to help. The risk of side-effects needs to be balanced against the risk of the damaging effects of the illness on a person's life.
No young person should be taking medication unless they are reviewed regularly by a health professional.
This is to monitor the dose of the drug and to check for side-effects.
How else can I help?
Recognising and understanding your child's illness is a huge step in knowing how you can help. When your child becomes irritable or even does something risky, it is common for you to feel angry or upset. It is important that you try to remain calm and be honest about letting the child know what you feel and seek help.
Some children may be reluctant to talk to you about their problems, although they might talk to someone at school, a friend or their GP, or a professional for young people at a health centre or CAMHS. It is important to encourage them to talk to someone they can trust, as well as seeking professional help.
Having little chats, spending time with the young person watching TV, cooking and doing physical activities such as walking can help to lift their mood, even if they say they do not want to do it. A healthy diet and physical exercise can help improve their mood.
Further reading and references
- Rutter's Child and Adolescent Psychiatry (5th edn), edited by Sir Michael Rutter, Dorothy Bishop, Daniel Pine, et al. Wiley-Blackwell, 2008
- Bailey S, Shooter M (eds) The Young Mind: An Essential Guide to Mental Health for Young Adults, Parents and Teachers. RCPsych Publications, 2009
- Mufson L, Sills R. Interpersonal psychotherapy for depressed adolescents (IPT-A): an overview. Nord J Psychiatry 2006; 60: 431-7
- Depression in Children and Young People (CG28). NICE, 2005
Content used with permission from the Royal College of Psychiatrists website: Depression in young people - helping children to cope: information for parents, carers and anyone who works with young people (September 2012, due for review September 2014). Copyright for this leaflet is with the Royal College of Psychiatrists.