Major depression

We understand that you may have a lot of questions when your child is diagnosed with depression:

• What is it?
• What caused it?
• What are the treatments?
• Will my child get better?
• How long will it take?

We’ve tried to provide some answers to those questions on these pages, and when you meet with our doctors, they can fully explain your child’s condition.

What is childhood depression?
Childhood depression is a mental health disorder characterized by a sad mood that is both prolonged and severe. Typically, if your child has major depression, he:

• is in a depressed or irritable mood for most of the day nearly every day
• shows a noticeable decrease in interest or pleasure in nearly all activities
• may have severe problems with eating, sleeping, energy and concentration, feelings of worthlessness or extreme guilt and even little desire to live

In order for your child’s problems to be considered major depression, three conditions must be met:

1. Symptoms must persist for at least two weeks.
2. The problems must cause distress and/or impair his function at home, at school or with friends.
3. The mood must represent a distinct change from how he was before.

Major depression can be treated with medication, therapy and hospitalization, if necessary.

What’s the difference between depression and grief?
Grief is a normal and natural response to loss. While grief and depression share certain symptoms (e.g. sadness, too much or too little sleep, changes in eating patterns), grief is not as constant. In other words, a person who is grieving may feel very sad when thinking about or remembering the loss, but feel somewhat better around friends and family. But someone with depression rarely finds relief from his or her sadness. Learn more about grieving and bereavement. 

What are the risks of depression?
If you think your child might be depressed, it’s important that he is evaluated sooner rather than later. If left untreated, depression could lead to:

• failure in school
• involvement in risky behaviors
• difficulties with jobs and relationships in adulthood
• attempted or successful suicide

Causes

Why do children become depressed?
While the exact cause of depression and other mood disorders is not known, they've been linked to genetics and environmental factors. The most common factors associated with major depression include:

• family history of depression
• parents’ divorce
• excessive stress
• abuse or neglect
• trauma (physical and/or emotional)
• loss of a parent, caregiver or other loved one
• loss of a relationship, such as moving away or loss of boyfriend/girlfriend
• failure to accomplish tasks such as learning to read, or keeping up with peers in other activities
• chronic illnesses, such as diabetes
• other psychiatric disorders
• other developmental, learning or conduct disorders

There are biological, psychological and social factors that can contribute to depression separately or in combination.

Biological

• Depression is thought to be caused by a difference in the structure and function of your child’s brain that controls the intensity of sad or irritable moods.
• There may be a genetic component. If other members of your family have had depression, your child is more likely to develop it, too.

Psychological

• Children have different temperaments. Two siblings can be raised in the same environment, and one may have depression, and the other may not.
• Some children are simply quieter than others, and less likely to talk about the things that are bothering them.

Environmental

• A stressful environment at home, school or in the community can contribute to depression.
• Your child may experience depression if he feels unhappy with his environment and powerless to make any change to it.

No matter what the underlying cause, we know how hard depression can be on your child and your family both, and we’re here to help.

Could a physical illness be causing my child’s depression?
Low thyroid levels may sometimes cause fatigue and other symptoms that may mimic symptoms of depression. Your child’s doctor can discuss this with you in more detail.

Signs and symptoms

What are the signs and symptoms of depression?

While each child may experience symptoms differently, some of the most common include:

• persistent feelings of sadness
• feeling hopeless or helpless
• having low self-esteem
• feeling inadequate
• excessive guilt
• loss of interest in usual activities or activities once enjoyed
• difficulty with relationships
• sleeping too much or too little
• changes in appetite or weight
• decreased energy
• difficulty concentrating
• trouble making decisions
• suicidal thoughts or attempts
• frequent physical complaints such as headaches, stomach aches or fatigue
• running away or threats of running away from home
• hypersensitivity to failure or rejection
• irritability, hostility, aggression

In order for your child’s problems to be considered major depression, three conditions must be met:

1. Symptoms must persist for at least two weeks.
2. The problems must cause distress and/or impair his function at home, at school or with friends.
3. The mood must represent a distinct change from how he was before.

Long-term outlook

What’s the long-term outlook for my child?

Depression is considered to be a recurrent illness. It’s impossible to say for sure for any given child, but it is thought that:

• one-third of children respond to a course of medication and therapy and then never need it again
• one-third of children may experience another bout of depression and need to go back on medication and/or re-enter therapy
• one-third of children may need to stay on medication and/or in long-term therapy

FAQ

Q: Will my child get better?
A: The majority of children respond to treatment for depression, so it’s most likely that your child will, too.

Q: When?
A: This depends on many factors. A child who is good at communicating may benefit from talk therapy (our primary method of treatment) more quickly than a child who is more hesitant. If your child is taking medication, it may take a while to find the ones that work best.

Q: What is the treatment for depression?
A:Treatment for depression may be biological, psychological and environmental:

• biological- your doctor may prescribe anti-depressants or other drugs that can help with your child’s depression.
• psychological – your child may benefit from talk therapy, which is aimed at learning helpful thinking and coping skills to overcome symptoms and adopt new, healthier thought patterns and behaviors.
• environmental– if your child’s situation at home or school is stressful, a change may help end his depression.

Another psychological treatment may simply be time. Your child’s brain is continually growing and developing, usually until he is 22 to 24 years old. Depression often goes away on its own as a teenager enters his early 20s and becomes better able to manage his thoughts and feelings.

Q: How can I pay for my child’s treatment?
A: If you have health insurance, many plans cover mental health treatments. Our How-to Guide to Children’s Mental Health Services in Massachusetts can help you figure out other ways to get your child the help she needs.

Q: What is dysthemic disorder?
A: Dysthemic disorder, or “dysthemia,” is a milder form of depression. If your child has dysthemia, he will be in a depressed or irritable for most of the day, more days than not, for at least a year. He may not seem as depressed as a child with major depression, but still not function or feel well.

To be diagnosed with dysthemia, your child must show impaired functioning at home, school and/or with friends. Children with dysthemia may also experience a bout of major depression; this is sometimes called “double depression.”

It's estimated that around four out of 100 chldren and teens have dysthemia, and it' s equally common in boys and girls. Children with dysthemia are mroe likely to develop major depression as teenagers or young adults.

Q: Are antidepressants safe for children to take?
A: The safety and efficacy of antidepressants for children and teens have been studied extensively. Prozac and other medications known as selective serotonin reuptake inhibitors (SSRIs) have been shown to be safe in most studies and can be effective for teenagers, but should be carefully monitored by the prescribing physician. If your child’s treatment provider thinks that she may benefit from taking antidepressants, she will discuss this with you in detail.

Q: What is the “black label warning” I keep hearing about when it comes to certain psychiatric medications?
A: Since 2004, the U.S. Food and Drug Administration has placed a black warning label on antidepressant medications, warning that antidepressants can increase the risk of suicidal thinking and behavior in children and adolescents with major depression and other psychiatric disorders.

If your child is prescribed antidepressants, we will carefully go over the specifics of the drug, as well as any potential side effects you should watch for. Our expert team has years of experience in managing the use of psychiatric medications in children. We will always closely monitor your child for any sign of a negative response to the medication, and are always here to answer your questions and address any concerns you may have.

Q: What should I do if I think my child is depressed?
A:If you think your child is depressed, it’s important that you take him to be evaluated as early as possible. Contact your child’s pediatrician, who may refer you to a mental health professional.

If you’re concerned that your child might harm herself or others, call your child’s mental health practitioner or primary care doctor immediately. If he or she is unavailable, take your child to the emergency room. It’s very important that you take any signs that your child may be suicidal seriously. Learn more about teen suicide. 

Questions to ask your doctor

After hearing that your child has been diagnosed with depression, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you.

Lots of parents find it helpful to jot down questions as they arise – that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed. If your child is old enough, you may want to suggest that he write down what he wants to ask his health care provider, too.

Here are some questions to get you started:

• What criteria and procedures will you use to diagnose my child?
• What are the treatment goals for my child?
• How can I tell if my child is making progress?
• How should I involve my child's school in treatment?
• How should I explain my child's condition to other members of the family?
• Will you prescribe medication for my child and why?
• How did you reach a diagnosis of depression?
• Could these symptoms point to any other condition?
• How can my family and I best support my child through treatment?
• How can I encourage my child to talk and ask questions about depression?
• Does anything in my child’s day-to-day routine need to change?
• How long will it take for my child to start feeling “back to normal”?