Understanding Depression

About Depression

Depression isn't just bad moods and occasional melancholy. It's not just feeling down or sad, either. These feelings are normal in kids, especially during the teen years. Even when major disappointments and setbacks make people feel sad and angry, the negative feelings usually lessen with time.

But when a depressive state, or mood, lingers for a long time — weeks, months, or even longer — and limits a person's ability to function normally, it can be diagnosed as depression.

Types of depression include: major depression, dysthymia, adjustment disorder with depressed mood, seasonal affective disorder, and bipolar disorder or manic depression. All of these can affect kids and teenagers.

Major depression is a serious condition characterized by a persistent sad mood, feelings of worthlessness or guilt, and the inability to feel pleasure or happiness. Major depression typically interferes with day-to-day functioning like eating and sleeping.

A child with major depression feels depressed almost every day. In kids, depression can appear as "bad moods" or irritability that persists for a long time, even if a child doesn't acknowledge being sad.

Dysthymia may be diagnosed if sadness or irritability is not as severe but continues for a year or longer. Kids with dysthymia often feel "down in the dumps." They can have low self-esteem, feel hopeless, and even have problems sleeping and eating.

Unlike major depression, dysthymia does not severely interfere with day-to-day functioning but the "down mood" is a pervasive part of the child's world. However, at least 10% of those with dysthymic disorder go on to develop major depression.

Bipolar disorder, another type of mood disturbance, is characterized by episodes of low-energy depression (sadness and hopelessness) and high-energy mania (irritability and explosive temper). Bipolar disorder may affect as many as 1% to 2% of kids. More than 2 million adults have bipolar disorder, which often develops in the late teen years and early adulthood.

Research in kids is not comprehensive, but experts believe that kids and teens with bipolar disorder can experience a number of problems, including attention deficit disorders, oppositional behavior disorders, anxiety, and irritability in addition to changes in mood from depression to mania.

Causes of Depression

Depression usually isn't caused by one event or reason, but is usually the result of several factors. Causes vary from person to person.

Depression can be caused by lowered levels of neurotransmitters (chemicals that carry signals through the nervous system) in the brain, which limits a person's ability to feel good. Genetics are likely involved as depression can run in families, so someone with a close relative who has depression may be more likely to experience it.

Significant life events such as the death of a loved one, a divorce, a move to a new area, and even a breakup with a girlfriend or boyfriend can bring on symptoms of depression. Stress also can be a factor, and because the teen years can be a time of emotional and social turmoil, things that are difficult for anyone to handle can be devastating to a teen.

Also, chronic illness can contribute to depression, as can the side effects of certain medicines or infections.

Diagnosing Depression

Kids with depression have described themselves as feeling hopeless about everything or feeling that nothing is worth the effort. They honestly believe that they are "no good," that their world is a difficult place, and that they're helpless to do anything about it.

But for an accurate diagnosis of major depression to be made, a detailed clinical evaluation must be done by a medical or mental health professional (such as a psychologist or psychiatrist). To meet criteria for a diagnosis, five or more of these symptoms must be present for longer than 2 weeks:

• a feeling of being down in the dumps or really sad for no reason
• a lack of energy, feeling unable to do the simplest task
• an inability to enjoy the things that used to bring pleasure
• a lack of desire to be with friends or family members
• feelings of irritability (especially common in kids and teens), anger, or anxiety
• an inability to concentrate
• a marked weight gain or loss (or failure to gain weight as expected), and too little or too much interest in eating
• a significant change in sleep habits, such as trouble falling asleep or getting up
• feelings of guilt or worthlessness
• aches and pains even though nothing is physically wrong
• a lack of caring about what happens in the future
• frequent thoughts about death or suicide

For a diagnosis of dysthymia, someone must experience two or more of these symptoms almost all the time for at least a year:

• feelings of hopelessness
• low self-esteem
• sleeping too much or being unable to sleep
• extreme fatigue
• difficulty concentrating
• lack of appetite or overeating

Kids and teens who are depressed are more likely to use alcohol and drugs than those who aren't depressed. Because these can momentarily allow a person to forget about the depression, they seem like easy fixes. But they can make someone with depression feel even worse.

Recognizing Depression

If you think your child has symptoms of depression, it's important to take action. Talk with your child and your doctor or others who know your child well. Many parents dismiss their concerns, thinking they'll go away, or avoid acting because they may feel guilty or prefer to solve family problems privately.

For a long time, it was commonly believed that children did not get depressed and that teenagers all went through a period of "storm and stress," so many kids and teens went untreated for depression. Now more is known about childhood depression and experts say it's important to get kids help as soon as a problem is noticed.

Parents often feel responsible for things going on with their kids, but parents don't cause depression. However, it is true that parental separation, illness, death, or other separation can cause short-term problems for kids, and sometimes can trigger a problem with longer term depression. This means that if your family is going through something stressful it's usually helpful to turn to a counselor, therapist, or other expert for support.

It's also important to remind your child that you're there for support. Say this over and over again — kids with depression need to hear it a lot because sometimes they feel unworthy of love and attention.

Remember, kids who are depressed may see the world very negatively because their experiences are shaped by their depression. They might act like they don't want help or might not even know what they are really experiencing.

If You Suspect a Problem

The good news is that professionals can help. Depression can be successfully treated in more than 80% of the people who become depressed. But if it goes untreated, it can be deadly — it is a major risk factor for suicidal behavior.

Depression can be treated with psychotherapy, medicine, or a combination of therapy and medicine. A psychiatrist can prescribe medicine, and although it may take a few tries to find the right drug, most people who follow their prescribed regimen eventually begin to feel better.

Psychotherapy focuses on the causes of the depression and works to help change negative thoughts and find ways to allow someone to feel better. Cognitive behavioral therapy has been shown to be very effective in treating depression, as well as anxious feelings that may come with it. Depression can be caused by and maintained with negative thinking, and this type of therapy, when given by a trained professional, can be extremely effective in helping fight it.

Getting Help for Your Child

Your first consultation should be with your child's pediatrician, who probably will perform a complete examination to rule out physical illness.

If depression is suspected, the doctor may refer you to a:

• psychiatrist: a medical doctor who can make a diagnosis, offer treatment, and prescribe medicine
• psychologist: a health professional who can diagnose and treat depression but is unable to write prescriptions
• licensed clinical social worker: a person who has a degree in social work and is qualified to treat childhood depression

When it comes to managing your child's depression, all of these health professionals can help. The important thing is that your child feels comfortable with the person. If it's not a good fit, find another.

Your child's teacher, guidance counselor, or school psychologist also might be able to help. These professionals have your child's welfare at heart and all information shared with them during therapy is kept confidential.

Treating Depression

Don't put off your child's treatment. Early detection and diagnosis are key in treating kids with depression.

A child or adolescent psychiatrist or psychologist can perform a complete evaluation and start a treatment plan that may include counseling, medicine, or both. The counselor might prescribe some sort of group counseling where the family works with the child in therapy sessions.

Depending on your child's age and maturity, it may be beneficial for him or her to participate in treatment decisions.

What Can I Do to Help?

Most parents think that it's their job to ensure the happiness of their kids. When your child's depressed, you may feel guilty because you can't cheer him or her up. You also may think that your child is suffering because of something you did or didn't do. This isn't true. If you're struggling with guilt, frustration, or anger, consider counseling for yourself. In the long run, this can only help both you and your child.

Other ways to help:

• Make sure your child takes any prescribed medicines and encourage healthy eating too, as this may help improve mood and outlook.
• Make sure your child stays active. Physical activity has been shown to help alleviate the symptoms of depression. Incorporate physical activities, such as bike rides or walks, into your family's routine.
• Offer your love and support and remind your child that you're there and want to hear what he or she has to say, even if it isn't pleasant. Although these things may be difficult for your child to believe, it's important for you to say them.
• Accept the situation and never tell your child to "snap out of it." Remind yourself that it isn't laziness causing your child's inability to get out of bed, complete chores, or do homework. He or she simply doesn't have the desire or the energy. However, you can still praise and reward your child for making extra effort.
• Watch for warning signs, and make sure the prescribed treatment is followed, whether it's medication, therapy, or both. Call the doctor if you see signs that your child may be thinking about self-harm. If your child talks about suicide, to you or anyone else, or shows warning signs such as giving belongings away and being preoccupied with death, call your doctor or a mental health professional immediately.

Depression can be frightening and frustrating for your child, you, and your entire family. With the proper treatment and your help, though, your child can start to feel better and go on to enjoy the teen and adult years.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: October 2011