Questions & Answers
What is depression?
In adults, Major Depression is diagnosed when there is a depressed or irritable mood and/or a loss of interest and pleasure in activities for at least two weeks. Adult depression often appears for the first time during the teen years, but when it begins, depression often goes unnoticed. This happens for many reasons. For one, depression looks different in teenagers than it does in adults. It can be hard to recognize the signs. Second, many adults expect teens to be moody and rebellious, considering it a normal developmental stage. A depressed or negative mood is a common experience, and many things can cause it. If it passes in a few days to a week, there is nothing to be concerned about. But unfortunately, what often looks like normal teen moodiness can be a more serious depression.
How can my child be depressed if he runs around and looks like he's having a good time?
Depression in children looks different than it does in adults. It is rare for young children to look down or sad for long periods of time. The depressed child is more likely to be irritable, complain of being bored, and difficult to please.
My child says "I want to die." Is this normal?
There is reason to be concerned if your child makes this type of statement. Parents should take it seriously and a professional evaluation is warranted. This does not necessarily mean that the child is suicidal. However, if he or she is seriously depressed there are ways in which medication and/or other forms of treatment will be helpful. Parents should also be aware that not all suicidal children express their thoughts verbally. Withdrawal, isolation, moodiness, or upset over certain events can also be a red flag. Children and teens who talk about suicide or death are not necessarily just looking for attention.
What are some of the signs of depression?
The most prominent indicator of teenage depression is irritability. If a teen is depressed, they "just don't seem like themselves." There will be a change in their behavior, so look closely. Look for any unusual behaviors like substance abuse or impulsivity, self-destructive behavior, irritability or aggression, thoughts about death and dying, poor self-esteem or guilt, restlessness or agitation, sadness or hopelessness, low energy or motivation, changes in hygiene or concerns about body image and appearance. If depression is severe it will interfere with normal everyday activities. Depression may get in the way of friendships, family relationships and school performance. You might notice grades drop or difficulty in concentrating or paying attention.
Where does my child's depression come from? No one in my family is depressed.
We do not know of one single reason why some children get depressed. For some children, depression seems to be a biological response that is not under their control. We do know that depression does not stem from children being spoiled or indulged.
How common is teenage depression?
Depression is more prevalent in teens than in children and adults. An estimated 2 million teenagers suffer from depression in the United States. 8% of teenagers are affected, compared to 1% of children and 5% of adults. This is a major health problem for teens. In fact, 1/3 of all adolescents who seek psychiatric help are depressed. However, 2/3 of depressed adolescents never get the help they need. Teenagers with depression are also at significant risk for suicide, which has increased by more than 200% over the last decade.
How can you help a teenager who is depressed?
Depression plays tricks on people, making them see themselves, other people and the world in a negative way. Take the teen's comments seriously and don't try to convince them not to feel bad. Ask them what might be helpful, but don't promise to keep the information secret. Don't assume someone else is handling the problem. Ask for help. There are many organizations and clinicians dedicated to working with children and adolescents who suffer from depression and other emotional difficulties.
What kind of treatments are available?
Psychotherapy, medication or a combination of the two. If the depression is severe, medication is often recommended to alleviate the distressing physical symptoms (such as sleeping and eating disturbances); to improve mood; and to facilitate the ability to participate in therapy. Research has shown that Cognitive-Behavioral Therapy (CBT) is effective for treating depression. The cognitive component helps teens change how they think about a situation and the behavioral component helps them change how they react to the situation. CBT can also aid adolescents in developing better social skills, problem solving skills and assertiveness skills to help them succeed in their relationships.
Isn't there anything else to help depression besides medication?
So far there is no clear evidence as to whether medication or behavioral treatment is more effective in treating children with depression. They can be equally effective, and a parent, child, and professional may choose one or both. However, if a child is suicidal or has difficulty with basic everyday functions, medication should be considered. For most kids, most of the time, medication alone is not enough. A supportive, understanding, caring environment is also necessary medicine.
Will the medication make children "high" or change their personality?
No. Taking medication for depression can be compared to taking medicine for a horrible headache. A headache can make you irritable, distracted, and unable to enjoy or focus on activities. A headache makes it difficult to get through the day. Medication doesn't change who you are, but it takes away the headache so you can act like yourself again . Similarly, the medication for depression lets the child be him or herself and pursue and enjoy activities. Children who are medicated for depression should be carefully monitored by their physician.
How long does a child have to take medication?
Once an appropriate medication and dose is determined and a child is doing well, it is usually advisable to continue at that level for a year. At that time it may be worthwhile to start a program of tapering and withdrawing medication. Sometimes if the depression is episodic, all that is needed is a short course of medication to help a child get over a bout of depression.