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Adolescent Depression…Is it a Phase or a Problem?

Although most people think of depression as an adult illness, children and adolescents can develop depression as well. Unfortunately, many children with depression go untreated because adults don't recognize they're depressed.

When teens are struggling with emotional issues such as depression, they can turn to drinking or drugs as a means of self-medication to alleviate the negative feelings they are experiencing. This self-medication can grow into a much larger problem over time.


Parents, teachers, and other adults need to learn about childhood depression. When you understand the symptoms of depression in children and why children develop it, you can intervene helpfully.


Symptoms

Depression in adolescents often presents differently than it does in adults. Irritability and anger are more common signs of depression in children and teens. Additionally, young children often find it challenging to explain their feelings, while teens may attempt to hide their emotional pain, fearing judgment from others.


Because normal behaviors vary as children develop, it can be challenging to know if your child is going through a phase or something more serious. The first step towards helping your child battle depression is learning how to spot it.


According to the American Academy of Child and Adolescent Psychiatry, common signs of depression in children and teens last longer than two weeks and include:

  • Changes in appetite or weight

  • Feeling or appearing depressed, sad, tearful, or irritable

  • Fatigue or perceived lack of energy

  • Feeling guilty or ashamed

  • Having more trouble concentrating

  • Loss of interest or pleasure in previously enjoyed activities

  • Psychomotor slowing or agitation

  • Recurrent thoughts of suicide or death

  • Sleep disturbance: Insomnia or hypersomnia nearly every day

In addition to the above symptoms, some children have physical complaints, such as stomachaches and headaches, substance use, and poor school performance.


Causes

While stressful life events, like divorce, may contribute to depression, it's only a tiny piece of the puzzle. Many other factors, including genetics, also influence its development.


Several different factors can contribute to childhood depression, including:

  • Brain chemistry: Imbalances in certain neurotransmitters and hormones may affect how the brain works, affecting moods and emotions and increasing the risk of experiencing depression.

  • Environmental factors: A stressful, chaotic, or unstable home environment can also make children more likely to experience depression. Rejection and bullying at school may also be a contributing factor.

  • Family history: Children with family members who also have mood disorders such as depression are at a greater risk for experiencing symptoms of depressive disorders.

  • Stress or trauma: Sudden changes such as moving or divorce or traumatic events such as abuse or assault can also contribute to feelings of depression.

Anyone can develop depression, and it isn't a sign of weakness. It also isn't your fault if your child is depressed.


Diagnosis

If you think your child is showing signs of depression, schedule an appointment with your child's pediatrician to discuss your concerns.


Before arriving at a diagnosis, your child must undergo a comprehensive physical and medical evaluation. Both will rule out any underlying medical conditions contributing to your symptoms. For example, thyroid problems, anemia, and vitamin deficiency can all mimic symptoms of depression.


While there is no specific test for depression, a doctor may use one or multiple psychological assessments to evaluate further the type and severity of depression your child is experiencing.


Classification of Depression

When your child is diagnosed with a depressive disorder, it is typically classified by severity:

  • Mild

  • Moderate

  • Severe (also called "major" or "clinical")

According to the DSM-5, this classification is based on the number, type, and severity of symptoms and the degree to which they interfere with your day-to-day life.


Depression Treatment

If your child is diagnosed with mild depression, their doctor will monitor their symptoms before recommending any treatment. If their symptoms persist after 6 to 8 weeks of support, they will be referred for psychotherapy. If your child is initially diagnosed with moderate to severe depression, their doctor will likely skip this step and start treatment immediately.


Psychotherapy, medications, or a combination have been shown to help young people with depression. The kind of treatment recommended for your child will depend on the nature and severity of their depression.


Psychotherapy

If your child is diagnosed with mild depression, the APA recommends psychotherapy as a first-line treatment. For adolescents with moderate to severe depression, research has shown that a combination of psychotherapy and medication works best.


In psychotherapy, a mental health professional will help your child develop the skills needed to manage their depressive symptoms to function well at home and in school. Two kinds of psychotherapy are recognized as the treatment of choice for children with depression:

  • Cognitive behavioral therapy (CBT): Helps improve a child's mood by identifying negative thought and behavior patterns and replacing them with positive ones.

  • Interpersonal therapy (IPT) is an approach in which therapists help adolescents learn how to handle relationship problems that may contribute to or result from depression.

The APA recommends that psychotherapy always be a component of treatment for childhood and adolescent depression.


Medications

Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line antidepressant option for young people with depression. Only two SSRIs—Prozac (fluoxetine) and Lexapro (escitalopram)—are FDA-approved for use in young people with depression.


Their doctor may also prescribe a different SSRI or a serotonin-norepinephrine reuptake inhibitor (SNRI) if they think it is in your child's best interest.


Antidepressants and Suicidal Thinking

While antidepressants can effectively treat childhood depression, their use has been linked to severe side effects, such as suicidal thinking in people under age 25. Though this side effect is rare, the Food and Drug Administration (FDA) now requires that all antidepressants carry a black box warning about this increased risk of suicide.

This does not mean that antidepressants should not be used by people in this age group. It simply means that they should be carefully monitored by doctors and caregivers, particularly in the first few weeks after starting an antidepressant.


Coping

For mild depression, lifestyle changes can often be an effective way to address feelings of depression. Finding ways to manage stress, getting regular physical exercise, using relaxation techniques, and building a more robust social support system can help improve how a child feels.


The following are some proactive steps you can take to encourage healthy coping skills and support mental health:

  • Talk about how caring for the body also helps the mind. Explain how eating nutritious food and exercising is good for their mental health.

  • Make sure your child has a consistent sleep schedule. Turn off devices before bedtime, and make sure your child goes to bed and wakes up simultaneously each day.

  • Please help your child develop a rich social life without over-scheduling their time. Assign responsibilities and reward them for being responsible.

  • Teach your child how to solve problems, manage their emotions healthily, and develop strategies to help them cope with failure and setbacks. Talk about your mental health and prioritize staying healthy in your family.

Ultimately, it's up to the guardians to decide what treatment options to employ. Parents and children must educate themselves about treatment and each option's potential risks and benefits.


Childhood depression can seriously impact a child's life, so it is always important to look for warning signs that your child may be depressed. Talk to your child about their feelings, and remain supportive and non-judgmental.


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Data Source: Nancy Schimelpfening, MS

Updated on June 28, 2021

Medically reviewed by Daniel B. Block, MD

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