Depression | Diagnosis & Treatments
How is depression diagnosed?
The first step in treating your child is forming an accurate and complete diagnosis. If you suspect your child is depressed, a mental health clinician (who may be a child/adolescent psychiatrist, child psychologist, or a social worker who specializes in child and adolescent mental health) will ask you and your child to come in for a visit. The clinician will ask about your child’s:
- symptoms
- social history
- medical history
- academic history
- family history
It can sometimes be hard to distinguish between sadness and grief and major depression. In order to correctly diagnose your child with depression, doctors use a standardized set of two types of symptoms that must be present.
Core symptoms
- persistent sadness
- persistent loss of interest in almost all activities
Associated symptoms
- loss of energy
- loss of appetite (or increase)
- changes in sleeping patterns
- agitation or irritability
- feelings of worthlessness or excessive guilt
- indecisiveness
- wanting to die
Depression is when one or both of the core symptoms persist for at least two weeks along with five of the associated symptoms. If the symptoms are due to substance abuse, a medical illness, or grief over a recent loss, they are usually not signs of depression.
When children have some symptoms, but not enough to indicate depression, they may have dysthemia.
What are the treatment options for depression?
Therapy
Talking with a therapist can help your child learn to manage sad feelings by developing new strategies. These include learning how to:
- identify and talk about feelings
- stop thinking automatically negative thoughts
- find activities that are soothing and comforting
- discover and appreciate good things about himself
- build hope for the future
Therapy can also help your child:
- work through difficult relationships and situations
- identify stressors in and figure out how to avoid or handle them
- improve his view of her environment
As with any treatment, parents and teachers play a vital and supportive role.
Medication
If your child's depression does not improve with therapy, or the depression is very severe, the doctor may prescribe antidepressants. These not only help your child feel better, but also help with motivation and coping skills in therapy.
Unfortunately, no single medication is effective in all children, and a trial-and-error period may last for weeks, or even months, as doctors find the best treatment for your child. When considering medication as a treatment option, the clinician will take into account:
- how well the drug has treats the symptoms your child has
- family history
- side effects of the drug
- how easy it will be to take the medication as prescribed
It's important to remember — and for your child to remember — that in order to have a chance for it to work, medication must be taken as prescribed.
Learn more about psychiatric medications for children and adolescents.
Environment
While not a treatment in the strictest sense of the word, paying attention to your child's environment can also help treat depression. If a situation at home could be contributing to depression, family therapy may be helpful. If other circumstances are triggering the sad feelings, and it is at all possible to change them, doing so will increase the chance of successful treatment.
If your child is diagnosed with a mental health condition in addition to depression, such as anxiety, treatment must address both conditions. If your child's depression is particularly severe, debilitating, or self-endangering, hospitalization may be required.
Depression | Frequently Asked Questions
Will my child get better?
The majority of children respond to treatment for depression, so it’s most likely that your child will, too. The time frame 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.
What is dysthemic disorder?
Dysthemic disorder, or “dysthemia,” is a milder form of depression. If your child has dysthemia, he or she will be in a depressed or irritable for most of the day, more days than not, for at least a year. They 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 also with friends. Children with dysthemia may experience a bout of major depression.
It's estimated that around four out of 100 children and teens have dysthemia, and it' s equally common in boys and girls. Children with dysthemia are more likely to develop major depression as teenagers or young adults.
Are antidepressants safe for children to take?
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.
What is the 'black label warning'?
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, your clinician will carefully go over the specifics of the drug, as well as any potential side effects you should watch for.
What should I do if I think my child is depressed?
If you think your child is depressed, it’s important to have an evaluation as soon as possible. Contact your child’s pediatrician, who may refer you to a mental health professional. If you’re concerned your child might harm themself or others, call your child’s mental health practitioner or primary care doctor immediately. It’s very important you take any suicidal signs seriously.
