Signs, Symptoms, Diagnosis, and Treatment

Signs

Short periods of feeling sad or down is a normal part of growing up. However, if your child or teen seems sad, isolated, irritable, and/or no longer seems to enjoy things he or she has always liked doing, and this has been going on for more than a week or two, your child might be suffering from major depressive disorder or, more simply put, depression.

Symptoms

Common symptoms of depression in children and teens include the following:

• Feeling or appearing depressed, sad, tearful, or irritable
• Not enjoying things as much as they used to
• Spending less time with friends or in after school activities
• Changes in appetite and/or weight
• Sleeping more or less than usual
• Feeling tired or having less energy
• Feeling like everything is their fault or they are not good at anything
• Having more trouble concentrating
• Caring less about school or not doing as well in school
• Having thoughts of suicide or wanting to die
• Having physical symptoms, such as frequent headaches or stomach aches.

Causes

Being in a stressful situation (e.g., parental divorce, physical or sexual abuse, bullying at school or through social media) or experiencing the death or long-term absence of a loved one might cause a child or teen to become depressed. Children and teens with learning disabilities, anxiety or other mental health issues, and/or conduct problems are also more likely to become depressed than other kids. Depression can also run in families. But sometimes depression just happens, and there doesn’t seem to be any reason why.

Diagnosis

If you suspect your child or teen is depressed, the best place to start is to try talking to your child about how he or she is feeling and if there is anything bothering them. Your child might be very forthcoming with you, openly talking about what’s going on in his
or her life and sharing any negative or suicidal thoughts he or she has been having. However, your child might not be willing or able to talk about his or her feelings/experiences and might even become completely closed off.
It’s important to remember, however, that you know your child better than anyone, and if something doesn’t seem right, then follow your instincts! Take your child to his or her pediatrician or to a qualified mental health professional who can conduct a comprehensive assessment, diagnose depression, and identify the right treatments. If you don’t have access to care or if you need additional guidance or insight regarding your child’s mood and/or behavior, your child’s school counselor is a good place to start. The school counselor can likely help refer you to someone qualified
to diagnose and treat depression in children.

Treatment

There are several effective methods for treating depression in children and teens, including psychotherapy and medication. Your child’s school counseling office, peer support or self-help groups, and family counseling might also be a part of the treatment plan. Your child’s physician should develop a comprehensive treatment plan based on the individual needs of you and your child, and should discuss with you the potential risks and benefits of all treatment recommendations so that you can make informed decisions regarding your child’s treatment.

Psychotherapy. Various forms of psychotherapy, such as cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), are helpful for treating mild-to-moderate forms of depression. CBT is designed to help your child recognize and change negative patterns of thinking and behavior that might contribute to depression. IPT can help your child find solutions to problems involving interpersonal relationships, which can both cause and result from depression. Only a licensed, trained healthcare professional should treat your child using these psychotherapeutic approaches.

Medication. Your child’s physician might recommend medication to treat your child’s symptoms of depression. Two selective serotonin reuptake inhibitor (SSRI) antidepressant medications have been approved by the United States Food and Drug Administration (FDA) for treatment of depression in children and adolescents. Fluoxetine
is approved for use in children as young as 8 years of age, and escitalopram is approved for use in children ages 12 years and
up. Other medications have been successfully used off-label (i.e., medications that have not been approved for use in children by
the FDA) to treat depression in children, and if your child does not respond to first-line medications (fluoxetine, escitalopram), your physician might recommend one of these alternative medications. About 60 percent of children/adolescents with depression will respond to medication alone. Of those who do not respond, a significant number respond to a combination of medication and psychotherapy. Once medication is initiated, it is recommended to allow 6 to 8 weeks to see if the medication works before making any treatment changes.

Combination approach. The third approach used to treat depression in children and adolescents is a combination of medication and psychotherapy. Combination therapy is often preferred because improvements in symptoms, functioning, and quality of life are usually seen much quicker using this approach than with psychotherapy or medication alone. For many adolescents, the best treatment will be a combination of individual psychotherapy and medication.

Summary

Early recognition and treatment of depression are critical to reducing suicide in children and teens. If your child is showing signs of depression for longer than a week or two, talk to your child openly and listen nonjudgmentally to learn more about what he or she is feeling and/or experiencing. Seek professional help right away if your child expresses feelings of deep sadness or thoughts of dying/suicide or if you just sense things are “off ” with your child, even if he or she doesn’t directly express it. Treating depression with a combination of antidepressant medication

and psychotherapy is recommended since this approach usually results in the fastest and most complete response in children and adolescents.

Adapted from American Academy of Child and Adolescent Psychiatry. Depression in Children and Teens. No. 4; Updated October 2018. https://www.aacap.org/aacap/ families_and_youth/facts_for_families/fff-guide/the-depressed-child-004.aspx. Accessed May 20, 2019. NHR

Resources

The American Academy of Child and Adolescent Psychiatry’s Resource Center offers families consumer- friendly definitions, answers to frequently asked questions, clinical resources, expert videos, and more on a variety of mental health issues that can affect children/ teens, including the following:

• ADHD
• Anxiety disorders
• Autism
• Bipolar disorder
• Bullying
• Trauma and child abuse
• Conduct disorder
• Depression
• Disaster
• Military families
• Moving into adulthood
• Obsessive-compulsive disorder
• Oppositional defiance disorder
• Substance use
• Suicide

Visit https://www.aacap.org/AACAP/Families_and_ Youth/Resource_Centers/Home.aspx to access this information. NHR