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Depression

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Introduction

The Questions and Answers that follow aim to provide an introduction to depression for parents and other family members. Following those, we offer links to selected resources for more information and support and a list of valuable services.
Note that we use the term doctor to refer to physicians, nurse practitioners, physician assistants, and other licensed clinicians who may care for your child.
More information about many topics relevant to children with depression and many other chronic conditions and their families can be found in the left menu. Detailed information aimed at primary care doctors can be found in our Depression module.

What is depression and what causes it?

Depression is a common but possibly serious mental health condition. Research suggests that it occurs when important chemicals in the brain are out of balance. It is more likely in people with a family history and it can be caused by life stresses and other mental health factors, although the cause may not be obvious.

What are the symptoms of depression?

People with depression do not all have the same symptoms. The types, severity, and duration of symptoms may be different in different people and across episodes for the same person. Episodes of depression can last from months to years, though most episodes will last six to twelve months.
Signs and symptoms may include:
  • Sad, anxious, or "empty" feelings that do not go away
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness, impatience
  • Loss of interest in favorite things or activities
  • Fatigue and a lack of energy
  • Problems concentrating, remembering details, and making decisions
  • Sleeplessness (insomnia), sleeping too much, or trouble staying asleep
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not go away even with treatment.

How is it diagnosed?

The first step is to visit a primary care doctor or mental health professional. Certain medications and some health problems such as viruses or thyroid issues can cause similar symptoms. A clinician can rule out these possibilities by doing a physical exam, interview, and lab tests.
A mental health evaluation will be important to identify the type of depression and the best approach to the symptoms. A mental health professional should talk with you about any family history of depression or other mental health conditions, and get a full history of the symptoms. The mental health professional may also ask about alcohol or drug use and thoughts of death or suicide. Once diagnosed, a person with depression can be treated in several ways.

What is the prognosis?

Most depression can be helped with psychotherapy and/or medication, along with support from family and friends. Depression may come back – up to 70% of teens with major depression will have some recurrence within 5 years. Self-harm or suicide can be avoided in most cases with treatment.

What is the risk for other family members or future children?

Depression appears to have a genetic component. The risk of depression in people who have a parent or sibling with depression is about two times as high as someone in the general population.

What treatments/therapies/medications are recommended or available?

Depression, even the most difficult cases, can be effectively treated. The earlier that treatment starts, the more effective it is. Most depressive episodes last from 6 months to one year, so the general recommendation for medications is that they be continued for at least one year from symptom improvement. Therapy should also continue at least that long.
In some cases of mild to moderate depression, psychotherapy alone may be a reasonable treatment option. This decision should be made with your primary care clinician. Be aware that the benefits of psychotherapy may take a while to realize.

How will my child’s and our family’s life be changed?

The impact of depression on a child or youth and their family will depend on the severity and the resources for treatment. In addition to good health care, positive support from family, friends, school, and the community are vital to improving outcomes.

How do children and youth experience depression?

A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may look sad, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they grow up, it may be hard to accurately diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop depression. By age 15, however, girls are twice as likely as boys to have had a major depressive episode. Depression in teenage years often co-occurs with other conditions such as anxiety, eating disorders, or drug abuse. It can also lead to increased risk for suicide.

Are antidepressants safe in children and adolescents? I heard that they could cause suicidal thinking.

In about 4% of children and youth who took part in studies of antidepressants, some worsening of suicidal thinking occurred. However, suicidal thoughts are also a symptom of depression, and these studies were not designed to test for this side effect. In over 4000 study subjects, none committed suicide. Be sure to discuss this with your clinician(s).

What illnesses often occur with depression?

Other illnesses may come on before depression, cause it, or be a result of it. But depression and other illnesses interact differently in different people. In any case, co-occurring illnesses need to be diagnosed and treated.
Anxiety disorders, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, social phobia, and generalized anxiety disorder often accompany depression. Alcohol and other drug abuse or dependence may also co-exist with depression. Treating the depression can also help improve the outcome of treating the co-occurring illness.

Resources

Information & Support

Where can I go for further information?
If you are unsure where to go for help, ask your primary care doctor. Others who can help are listed below.
Mental Health Resources:
  • Mental health professionals, such as psychiatrists, psychologists, social workers, or mental health counselors
  • Health care centers
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • Mental health programs at colleges or medical schools
  • State hospital outpatient clinics
  • Family services, social agencies, or clergy
  • Support groups
  • Private clinics and facilities
  • Employee assistance programs (EAPs)

For Parents and Patients

Support

Child and Adolescent Mental Health (NIMH)
Information about mental health conditions in children and adolescents, including a list of warning signs, featured videos, and health hotlines; National Institute of Mental Health.

National Alliance on Mental Illness (NAMI)
Provides information about mental illnesses, links to state chapters, information about conferences, and links to additional resources.

General

Mental Health America (MHA)
National non-profit organization, with numerous local affiliates, dedicated to helping all people live mentally healthier lives. Includes information on a variety of mental health topics in English and Spanish.

Understanding Depression (KidsHealth)
How to recognize depression in children, give support, and seek help.

The Depressed Child (AACAP)
Common symptoms of depression in children and teenagers; American Academy of Child and Adolescent Psychiatry.

Children's Mental Health (MHA)
Policy, advocacy, information, and referral to maximize mental health for people of all ages; Mental Health America.

Depression and Other Disorders (SAMHSA)
Information about depression, anxiety disorders, and others.

Depression (NAMI)
Explanations of treatment for various mental disorders, including depression, and suggestions for how to help yourself or others who are struggling with mental health issues ; National Alliance on Mental Illness.

Child Mental Health (Medline Plus)
A brief summary of mental health conditions in children and numerous links to other resources.

Teen Mental Health (Medline Plus)
A brief summary of teen mental illness and numerous links to many other resources.

Allies with Families
Provides emotional support, training, and resource information for families of children with emotional, behavioral, and mental health disabilities; also includes workshops for siblings.

Teens & Young Adults (NAMI)
Focused information about adolescent depression, how to find help, and links to a teen mental health forum called Ok2Talk; National Alliance on Mental Illness.

Services for Patients & Families in Montana (MT)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Studies

Depression in Children and Adolescents (ClinicalTrials.gov)

National Institute of Mental Health Current Clinical Trials - Depression

Authors & Reviewers

Initial publication: March 2012; last update/revision: January 2019
Current Authors and Reviewers:
Contributing Author: URLEND Trainees, 2011-2012
Reviewer: Tina Persels
Funding: The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.
Authoring history
2012: first version: Thomas G. Conover, MDR
AAuthor; CAContributing Author; SASenior Author; RReviewer