Montana Medical Home Portal

Introduction

Here you’ll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in the Depression module, which is written for primary care clinicians but also may be of help to parents and family members.

What is depression and what causes it?

Everyone occasionally feels blue or sad. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression illnesses are disorders of the brain, and are common but serious. Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors. Longstanding theories about depression suggest that important neurotransmitters are out of balance.

What are the symptoms of depression?

People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness. Depression is most commonly episodic. Episodes can last from months to years. The majority of episodes will last from 6 months to one year.

Signs and symptoms include:

Persistent sad, anxious, or "empty" feelings
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Irritability, restlessness
Loss of interest in activities or hobbies once pleasurable, including sex
Fatigue and decreased energy
Difficulty concentrating, remembering details, and making decisions
Insomnia, early-morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

How is it diagnosed?

The first step is to visit a medical doctor or mental health specialist. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A clinician can rule out these possibilities by doing a physical exam, interview, and lab tests. If the clinician can find no medical condition, the next step is a psychological evaluation. A mental health professional should discuss any family history of depression or other mental disorder, and get a complete 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?

Depression is most often recurrent. Up to 70% of adolescents with major depression will experience some degree of recurrence within 5 years.

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

Depression does appear to have a genetic component. Risk of depression in first degree relatives of a person with depression is about 2 times as high as someone in the general population.

What treatments/therapies/medications are recommended or available?

Depression, even the most severe cases, can be effectively treated. The earlier that treatment can begin, the more effective it is. The majority of depressive episodes will 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 probably 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 in collaboration with your primary care clinician. Be aware that the positive effects of psychotherapy may take longer to realize than those of medication.

How will my child and our family be impacted?

The impact of depression on a child or adolescent with depression and her family will depend on the severity of the depression and the resources that are available to treat the child. In addition to good health care, positive support from family, friends, school, and the community are critical to optimizing health and functional outcomes.

How do children and teens 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 sulk, get into trouble school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult 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 adolescence frequently co-occurs with other disorders such as anxiety, eating disorders, or substance 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 adolescents participating in studies of antidepressants, some degree of worsening of suicidal thinking occurred. It is important to note that suicidal thoughts are also a symptom of depression, and these studies were not designed primarily to assess for this side effect. Even more important to note is that in over 4000 subjects, 0 committed suicide in these studies.

What illnesses often co-exist with depression?

Other illnesses may come on before depression, cause it, or be a consequence 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 substance 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 family doctor. Others who can help are listed below.
Mental Health Resources:

Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
Mental health programs at universities or medical schools
State hospital outpatient clinics
Family services, social agencies, or clergy
Peer support groups
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies

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 other services related to this condition, browse our Services categories or search our database.

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: November 2015

Current Authors and Reviewers (click on name for bio):

Contributing Author:	URLEND Trainees, 2011-2012
Reviewer:	Thomas G. Conover, MD

Funding: The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.

Authoring history

(Limited detail is available on authoring dates before 2014.)

^AAuthor; ^CAContributing Author; ^SASenior Author; ^RReviewer