The first step in treating your child’s dysthymia is forming an accurate and complete diagnosis.
How is dysthymia diagnosed at Children’s Hospital Boston?
A child psychiatrist, psychologist or social worker makes the diagnosis after conducting a comprehensive psychiatric assessment with you and your child. During the assessment—which is an interview—you will be asked about your child’s symptoms, as well as his social, medical, school and family histories.
Working with the Children’s mental health clinician, you will arrive at a formulation or explanation of your child’s problem, and can then begin a mutually agreed upon treatment plan.
Because depression has shown to often co-exist with other mental health problems, such as substance abuse and anxiety disorders, seeking a diagnosis and beginning treatment as soon as possible are very important.
Q: Are depressive disorders like dysthymia common in kids?
A: Yes. Depressive disorders, including dysthymia, are among the most common mental, emotional and behavioral problems affecting children. According to the U.S. Center for Mental Health Services, as many as one in every 33 children and one in every eight teens may be depressed.
Q: How can I tell if my child has dysthymia, or is just “going through a phase” or “down in the dumps”?
A: Nearly all children—and especially adolescents—go through pronounced phases of “moodiness,” wanting to be alone and fretting about their lives and relationships.
The difference between these normal ups and downs of teenage life and the presence of a depressive disorder is that a truly depressed child will experience extended and intense feelings of sadness, hopelessness and helplessness.
You should seek prompt treatment for your child if any of the following symptoms persist for two weeks or more:
- feeling sad, worried or hopeless
- expressing low self-esteem or making negative comparisons to peers (“I’m so stupid compared to everyone else in the class,” “I’m so much uglier than all my friends”)
- sleeping too often or not often enough
- withdrawal from family and friends (constantly staying in her room with the door closed, not taking calls or visitors)
- sudden change in weight or appetite
- unprovoked irritability, hostility or aggression
- diminished performance in school
- complaining of headaches, stomachaches or other physical symptoms with no identifiable medical cause
If your child:
- begins giving away treasured possessions
- refers to “not being around” in the future
- expresses a wish to “disappear” or “sleep forever”
- expresses a desire to die
- mentions a plan to die
… you should always take these warning signs of suicide very seriously and seek immediate help.
Q: Why is psychotherapy, or “talk therapy,” helpful in treating dysthymia?
A: Psychotherapy (“talk therapy”) has proven to be an extremely effective method of overcoming the seemingly “unshakeable” sad, hopeless feeling that is the calling card of dysthymia.
An experienced mental health professional will use psychotherapy to help your child adapt new, healthy and constructive responses to stress and sadness. Therapy will teach your child:
- how to vocalize feelings of hurt, anxiety, anger and low self-esteem
- techniques (such as deep breathing, meditation, exercise and mentally picturing a relaxing place or scenario) for reducing the physical feelings associated with depression
- new thought patterns to replace the destructive ones—for example, responding to an initial sense of hopelessness by remembering, “This is just my brain making me feel like this will go on forever. But really, it’s just a temporary feeling and I will work through it.”
- how to improve their problem solving abilities
- how to enhance their social skills
Q: Why do some children need antidepressant medication for dysthymia?
A: Some children may need medication to ease their feelings of sadness, tiredness and hopelessness to a manageable degree, so that they can begin to benefit from psychotherapy.
Here at Children’s, medication is never a standalone treatment—we only prescribe it in conjunction with talk therapy. Learn more about how Children’s prescribes psychiatric medication.
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. The warning label states, in part:
“Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.”
If your child is prescribed any medication for dysthymia, your clinician will carefully go over the specifics of the drug, as well as any potential side effects you should watch for. We will closely monitor your child for any sign of a negative response to the medication, and are always here to address any concerns you may have. However, evidence-based studies have shown that a combination of psychotherapy and medication are the most effective interventions for moderate or severe depressions.
Q: Can I prevent my child from becoming depressed?
A: There is some evidence that depressive episodes in children may be prevented. Through a series of long-term studies with families, William R. Beardslee, MD, Children’s academic chair of Psychiatry, has developed a step-by-step approach that helps families cope with depression while nurturing resiliency in children.
This approach is now being used across the country and around the world.
Q: What is the long-term outlook for my child?
A: The outlook for a child with dysthymia depends greatly on being diagnosed and properly treated as early as possible. If left untreated, dysthymia can lead to major depression, which carries a substantial risk of:
- failure, chronic absenteeism or dropping out of school
- involvement in destructive behaviors, including substance abuse
- difficulties with relationships, jobs and responsibilities in adulthood
- suicidal thoughts or attempts
The good news is that children with depressive disorders, including dysthymia, respond very well to psychotherapy and medication when treated by qualified mental health professionals.
Q: What if my child has been diagnosed with another mental health issue, in addition to dysthymia?
A: A child with dysthymia often has another mental health condition, including:
- another mood disorder (such as bipolar disorder)
- an anxiety disorder (such as obsessive-compulsive disorder (OCD) or social anxiety disorder
- attention-deficit hyperactivity disorder (ADHD)
If your child has another mental or behavioral health problem, the conditions must be treated at the same time. Your clinician will develop a dual treatment plan that meets your child’s specific needs.
Q: What is the most important thing I need to know about childhood depression?
A: If you suspect your child may be depressed, it’s essential that you speak with a qualified mental health professional as soon as possible. Children with depressive disorders respond well to treatment that is administered by trained clinicians. By closely working with the treatment team, you can help your child go on to enjoy an active and fulfilling life.
It’s also important to note that a depressed child can’t just “snap out of it,” or will herself out of her feelings—and telling her to do any of these things is likely to only make the depression worse. Like a child with a chronic medical illness, children who are depressed require qualified and consistent clinical care and family support.
|How Children’s is improving access to mental health care|
|Learn how Children’s is improving the coordination of psychiatric care for at-risk children and families.|
Questions to ask your doctor
You and your family play an essential role in your child’s treatment for dysthymia. It’s important that you share your observations and ideas with your child’s treating clinician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.
You’ve probably thought of many questions to ask about your child’s condition. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you will have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you. (If your child is old enough, you can encourage him or her to write down questions, too.)? ?Initial questions to ask your doctor might include:?
- What criteria did you use in reaching this diagnosis?
- Is it possible that these symptoms could point to any other condition?
- What are the treatment goals for my child?
- How can I encourage my child to talk to me and ask questions about his condition?
- What role should I play in my child’s treatment?
- How should I respond if my child is in the midst of a depressive episode?
- How long do you expect my child to need therapy?
- How can I tell if my child is making progress?
- Should I involve my child's school in treatment, and if so, how?
- How should I explain my child's condition to other members of the family?
- Will you prescribe medication for my child? If so, what are the possible side effects of this medication?
- How can my family and I best support my child through treatment?
- 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”?
- What other resources can you point me to for more information?
Please note that neither Children’s Hospital Boston nor the Department of Psychiatry at Children’s unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.
Helpful links for parents
- Childhood Depression: Information For Parents?
- Depression and Bipolar Support Alliance?
- Families for Depression Awareness
- The Depressed Child?
Helpful links for teens
Helpful links for younger children
- A Peptalk for Myself Journal Page?
- How Do You Feel? Coloring and Activity Book (Adobe Acrobat required to view and download)?
- It’s My Life
- National Mental Health Information Center: Kids’ Page?
- The Storm in My Brain (Adobe Acrobat required to view and download)?