Depression in Children and Young People
Depression is an illness that affects people of all ages, including children and young people. It is thought that about one per cent of children and three per cent of teenagers are affected by depression. Depressive symptoms are much more common than depressive disorder and may also require help.
Medical text written March 2014 by Professor D Cottrell, Professor of Child and Adolescent Psychiatry, Leeds University, Leeds, UK. Last updated August 2016 by Dr Bernadka Dubicka, The Junction Adolescent Unit, Lancashire Care Foundation Trust, Lancaster, UK.
Although great care has been taken in the compilation and preparation of all entries to ensure accuracy, we cannot accept responsibility for any errors or omissions. Any medical information is provided is for education/information purposes and is not designed to replace medical advice by a qualified medical professional.
The symptoms of depression in children and young people include changes in mood, thinking and behaviour. The key symptoms are:
- persistent sadness or low (irritable) mood
- loss of interests and/or pleasure
- fatigue or low energy levels.
These core symptoms may also be accompanied by:
- change in sleeping patterns – poor or increased sleep
- agitation or slowing of movement
- change in eating habits – poor or increased appetite
- low self-confidence and indecisiveness
- feelings of guilt, self-blame or worthlessness
- lack of concentration leading to lower school performance
- self-harm and possible suicidal feelings
- withdrawal from communication with other children and young people.
Depression usually has multiple causes. Commonly, a child or young person who is more vulnerable to depression because of genetic and biological factors, and early adverse experiences, will have their depression ‘triggered’ by an adverse life event against a backdrop of more chronic social or psychological difficulties. This can help explain why when more than one child experiences a similar adverse event or lives in similar psychosocial circumstances, not all will develop depression.
Possible biological factors include changes in monoamine transmitter levels (a special type of chemical in the brain), and also changes in cortisol metabolism. Common psychosocial difficulties include, for example, family disharmony, divorce, separation, domestic violence, child abuse, and school difficulties such as bullying, academic problems and/or isolation. Typical triggers include life events such as the breakdown of an important relationship or bereavement.
A diagnosis will usually be made after a healthcare professional talks with the child or teenager both with and without his/her parents. Information from others such as a teacher who knows the child or teenager may be sought. Occasionally, a physical condition can lead to symptoms similar to those of depression. For this reason, a physical examination may be needed to eliminate conditions such as glandular fever, anaemia, breathing problems such as sleep apnoea or thyroid disorders. If a diagnosis of depression is made, it may be described as mild, moderate or severe according to the number of symptoms that are identified.
Treatment of depression in children and young people falls into two categories: psychological treatments (psychotherapy or counselling – talking treatments); and physical treatments (medication). Psychological treatments should be suggested first. For mild depression, referral to a specialist may not be necessary and the healthcare professional may advise ‘watchful waiting’ – monitoring the progress of the young person accompanied by sensible advice about diet, exercise and encouraging the child to take part in normal activities.
If there is no progress or if the depression is more severe, psychological treatments such as cognitive behaviour therapy and interpersonal therapy will be suggested. Other psychological treatments that may be suggested include family therapy and more intensive individual child psychotherapies. If psychological treatments are not bringing about improvement, or if the depression is more severe, then, in teenagers, antidepressant medication will be suggested (and considered even in children) in addition to the psychological treatment. Where medication is prescribed, children and young people should be monitored carefully in the first few weeks for adverse effects.
The National Institute for Health and Clinical Excellence (NICE) has produced guidelines on the treatment of depression in children and young people for healthcare professionals, children and young people themselves, parents and carers (see the NICE website).
Information and support in the UK for depression in children and young people is provided by Young Minds and the Scottish Mental Health Association (see entry Mental Health).