Depression in Children

What are the signs of depression in children?

A young person with depression may experience problems not only with how they feel, but also with how they behave. This can cause difficulties at home and at school, as well as in relationships with family and friends. Typical signs and symptoms of depression in children and adolescents can include:

• Being moody and irritable - easily upset, angry or tearful.
• Not having as much energy as usual.
• Not enjoying activities that they usually like.
• Not taking care of themselves - personal hygiene, clothes etc.
• Avoiding friends, family, school and normal activities.
• Taking risks and self-harming.

Feelings they might have include:

• Feeling guilty or bad, being overly self-critical or hating themselves.
• Feeling hopeless and no point to living.
• Finding it difficult to concentrate.
• Feeling tired because they are having trouble sleeping.
• Not feeling hungry, eating too little (or sometimes too much).
• Having unexplained headaches or stomach aches.

Young people who have experienced more than one of these and have had them constantly for more than two weeks, might be depressed.

Some young people might start risky behaviours. These can include missing school, harming themselves through misusing drugs or alcohol, or having inappropriate sexual relationships. Sometimes young people with depression may self-harm, or try to kill themselves. If you are considering harming yourself, you should speak to someone you trust straightaway.

A small number of young people with depression may develop psychotic symptoms like hearing voices or believing that someone is trying to harm them. Some young people have periods of having a very low mood, followed by periods of having a very high mood. This might be a sign that they have bipolar disorder.

What causes depression in children?

Depression is not a sign of weakness, and it can happen to the most determined of young people. Some very famous and successful people experience depression. There will sometimes be a clear reason that someone becomes depressed, sometimes not. It can be a disappointment, a frustration, or because you have lost something or someone important to you. There is often more than one reason, and these will be different for different people. Some common reasons include:

• Life events like someone dying, moving schools or other big changes.
• Physical health problems.
• Experiencing physical, sexual or psychological abuse or neglect, witnessing violence or a traumatic event, or having an unstable family environment.
• Alcohol and drug use.
• Inherited (genetic) risk factors might make you more likely to develop severe depression. Having a parent with a serious mental illness (a family history) can also make this more likely.

When thinking about the causes of developing depression, it is important to remember that no one risk factor causes depression. It is usually a combination of reasons.

Risk factors for childhood depression

There are a few factors that make depression more likely in a child or young person:

• Their age - more common in teenagers.
• Sex - more common in girls.
• Family upset.
• Experiencing bullying or other physical or emotional abuse.
• Co-existing health problems.
• Family history of depression.
• Some specific situations are also associated with a high risk of depression, such as homelessness, refugee status and living in institutional settings.

How common is depression in children?

Childhood depression is thought to occur in about 2 out of 100 young people aged 5-19.

Anybody can experience depression and it affects people of all ages, ethnicities and social backgrounds. It is more common in older adolescents, particularly teenage girls.

How is depression in children diagnosed?

If you think depression might be the problem, you can speak to your GP. A child or young person might also be able to speak to their school nurse. Both of these will be able to tell you what help is available and arrange a referral to the local Child and Adolescent Mental Health Service (CAMHS). They will see you and your family and discuss what the right treatment is for you. If you would like to see a professional without your parents, you can ask to have all or part of the appointment on your own.

They will ask you about how you are feeling and try to support you in the most appropriate way. They will listen to your concerns.

How is depression in children treated?

There are many different treatments for depression. Which is used depends on several factors including age, family circumstances and how severe the depression is.

Self-help

If you think you might be depressed, try some of the following suggestions to see if they help you feel better:

• The first and most important thing to do is talk to someone you trust about how you're feeling.
• Once you have done that, you can talk with them about finding practical solutions to problems. For example, if there is a problem at school, letting your family or teachers know can help them to support you.

To help you feel better in yourself you should try to:

• Do some exercise and eat healthy food.
• Keep busy. This might be hard as you probably don't really feel like doing anything. If you keep trying it will get easier.
• Spend time with friends and family rather than being alone.
• Have fun and don't be too hard on yourself.

It's a good idea to learn more about depression and mental health problems. There are some websites in Further Reading below that you might find helpful.

Some people find online support groups helpful, as they allow them to connect with other people having similar experiences and learn more about depression and mental health problems. However, don't feel like you have to do this. If you see or hear things that are upsetting online, talk to someone that you trust.

Remember you are not alone - depression is a common problem and people do recover.

Tips for parents of young people with depression

Just realising there is a problem and trying to understand is a huge step. When your child becomes snappy or does something risky, it is hard not to feel angry or upset. It is important that you try to remain calm and be honest about letting them know what you feel.

Young children often express their feeling through play. If you notice their play involves a lot of fighting or violence, make a comment like, 'There's a lot of fighting going on', and wait for their response. It might give you a clue as to things that are worrying them.

There might be several reasons that older children may be reluctant to talk to you about their problems. They might think you have enough problems to deal with, or be worried about upsetting you. They might find it easier initially to talk to an older sibling, a good friend or someone at school. Their GP or a professional for young people at a health centre or child and adolescent mental health service (CAMHS) are other options. It is important to encourage them to talk to someone they can trust, as well as asking for some professional help.

In the meantime, spending time with them (for example, watching TV together, cooking and going for a walk) 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. Talking to them, even if you're not talking about how they feel, is important.

Psychological therapy

Cognitive behavioural therapy (CBT) is a type of talking therapy that is often used to help people with depression. It helps to manage problems by changing the way you feel, think and act. The therapy aims to find practical ways to help deal with problems in a more positive way by breaking them down into smaller parts - situations, thoughts, emotions, physical feelings and actions. CBT can be done face to face with a therapist, or online.

Medication

Antidepressant medicines are effective for treating depression. Around half of people with moderate or severe depression feel better within a few weeks of starting treatment. Children and young people are usually prescribed a medicine called fluoxetine by a specialist doctor. This is a selective serotonin reuptake inhibitor (SSRI) which is used to treat depression and some other conditions. They can take 6-8 weeks to build up their effect to work fully. A normal course of antidepressants lasts at least six months after symptoms have eased. Side-effects may occur but are often minor. At the end of a course of treatment, you gradually reduce the dose, as directed by your doctor, before stopping completely.

When to see a doctor

Many young people will get better on their own with support and understanding from those around them. Some young people might find online resources useful - see below.

However, you might need to seek professional support if you are not getting better, or feel as though you are getting worse, or if depression is causing significant difficulties for you.

If you have feelings that you want to hurt yourself, or if you are doing dangerous things to cope, like using alcohol or drugs, speak to someone you trust. It is important that you let someone know how you are feeling and get help quickly.

Your GP will assess how severe the depression is. They may recommend a therapy, or refer you to a child and adolescent mental health service who can devise a treatment plan..

Can depression in children be prevented?

It is almost impossible to prevent children feeling sad at some point in their lives. It is important to try to keep good communication with your child and give them options to express their feelings and concerns openly. Recognising changes in normal patterns of behaviour is important. Asking for support early can help to prevent a problem becoming more serious and long-term.