Depression in Children & Adolescents

Depression is common among children and teenagers. About 8 out of 100 teens have a severe episode of depression each year, and around 20 out of 100 will experience depression at some point during their teen years. While depression is more common in teens aged 12-18, younger children can also be affected. Before puberty, depression affects boys and girls equally, but after puberty, it becomes twice as common in girls.

It's important for parents to recognize the signs of depression in children and teens. By knowing these signs, you can help your child get the support and treatment they need. Remember, children and teens might not always talk about their feelings, so watch for changes in their behavior, mood, and daily activities.

If you notice any of these signs in your child, it might mean they are struggling with depression:

• Feeling sad or hopeless for a long time
• Being irritable or angry
• Staying away from friends and family
• Losing interest in activities they used to enjoy
• Changes in eating habits or weight
• Having trouble sleeping or sleeping too much
• Feeling very tired or having low energy
• Trouble concentrating
• Doing poorly in school
• Feeling worthless, very guilty, or having poor self-esteem
• Complaining of headaches or stomach aches without a clear cause
• Talking about death or suicide

Typical sadness is usually a reaction to a negative event or stress and lasts a few hours to a few days. Depression, on the other hand, can also be triggered by an outside event but involves episodes of sadness that are much more severe and last for weeks or months. These episodes affect a child's daily activities and functioning. Kids with depression often have persistent thoughts of poor self-esteem, hopelessness, and guilt, while with typical sadness, these thoughts are temporary.

While depression affects everyone, the signs can look different depending on age. Children and teens dealing with depression are more likely to show symptoms of irritability, anger, and emotional outbursts along with sadness, while adults typically experience pronounced sadness. Physical symptoms such as unexplained stomach aches or headaches are more common in children and teens compared to adults. Children and teens are also more likely to respond to a positive environment even when depressed, whereas adults' feelings are less likely to be influenced by their surroundings. Both adults and children or teens struggle with self-criticism, poor self-esteem, hopelessness, and guilt. However, adults are more likely to talk about these feelings and correctly label their emotions.

While typical sadness may get better on its own, depression often needs treatment to fully recover. Without help, depression can last longer and affect your child's school, friendships, and overall happiness. Getting support from a mental health specialist, therapist, or counselor can make a big difference in your child's recovery and well-being.

Depression is treated with therapy or a combination of therapy and medicine. Our providers choose the best treatment based on how serious the symptoms are, past treatments, how quickly help is needed, and the family's feelings about therapy and medicine. Therapy can be used alone or with medicine to help your child feel better.

Therapy is often the first choice for treating depression. At MindWeal, we recommend Cognitive Behavioral Therapy (CBT), which helps kids change negative thoughts and behaviors into positive ones. This helps them manage their depression and handle tough situations better. CBT can be used alone or with medicine, depending on what's best for your child.

Another effective therapy is Interpersonal Therapy (IPT), which focuses on improving relationships and solving problems. For more severe depression, Dialectical Behavior Therapy (DBT) can help. DBT teaches kids how to control their emotions and deal with stress.

Your therapist will choose the best type of therapy based on your child's needs and the most important issues to address.

Therapy can greatly help with anxiety, especially when the therapist is experienced and the individual attends regularly. However, it can be challenging. It requires regular sessions and a skilled therapist. Changing the way you think and handle stress can be tough, and therapy might be less effective if symptoms of depression are very severe or if there are additional mental health issues. In such cases, combining therapy with medication might be best.

Yes, medications can be very effective for treating depression in children and adolescents. Studies have found that kids who took medication for depression did better than those who took a placebo (a sugar pill). Research also shows that kids who take medication often see their depression improve faster than those who only go to therapy or do nothing. The best results usually come from combining medication with therapy.

The medications effective for treating depression in kids and teens are:

1. Selective Serotonin Reuptake Inhibitors (SSRIs): These are usually the first choice. They include Sertraline (Zoloft), Fluoxetine (Prozac), and Escitalopram (Lexapro).
2. Selective Norepinephrine Reuptake Inhibitors (SNRIs): These are recommended if SSRIs were not helpful. They include Venlafaxine ER (Effexor XR) and Duloxetine (Cymbalta).
3. Other Antidepressants: These include Bupropion (Wellbutrin) and Mirtazapine (Remeron). They can be added to SSRIs or SNRIs to boost their effectiveness.
4. Atypical Antipsychotics: These are added to antidepressants to make them more effective. They include Aripiprazole (Abilify) and Quetiapine (Seroquel).
5. Mood Stabilizers: These are added to antidepressant medications to improve their effects. They include Lithium and Lamotrigine (Lamictal).
6. T3 (a form of thyroid hormone): It can be added to antidepressant medications to help them work better and faster.

These medications have been shown to help manage symptoms of depression. Your child’s healthcare provider can help decide which medication is best for your child.

Choosing the right medication for your child's depression is a careful process. We only recommend medications that have been shown to work in research studies. Our choices are guided by practice guidelines from national organizations like the American Academy of Child & Adolescent Psychiatrists and the American Academy of Pediatrics.

The treatment guidelines recommend starting with an SSRI. If it doesn’t work, we try another SSRI. After two tries, we may switch to an SNRI. If these medications are only partly effective, we might add an atypical antipsychotic (Aripiprazole, Quetiapine), another antidepressant (Bupropion, Mirtazapine), a mood stabilizer (Lithium, Lamotrigine), or T3 to help.

Our providers look at your child's age, past medications and their effects, family history of medication responses, and the preferred form of medication (capsule, tablet, or liquid). By following these steps, we ensure your child gets the best possible care tailored to their needs.

To find the right dose for your child’s medication, we start with a low dose and gradually increase it. We continue this until we find the dose that effectively reduces symptoms without causing side effects. During treatment, you and your child will have regular check-ins with the clinician. These meetings allow us to see how well the medication is working and if there are any side effects. During these visits, the clinician will adjust the dose as needed to ensure your child gets the best results.

When your child starts taking medication for depression, you might see some improvement in 2 to 4 weeks, with more progress over 8 to 12 weeks. Some children feel better quickly with a low dose, while others might need a higher dose. We start with the lowest dose to help children get used to the medication and reduce side effects. Each dose is given about a month to work. If it doesn’t help, we increase the dose. Finding the best dose can take 8 to 12 weeks. Full benefits are usually seen after 6 to 9 months of treatment. It's important to be patient and trust the process. With time and the right support, your child can start to feel better.

Yes, your child may experience some side effects from the medication at first. Common side effects from SSRIs include headaches, trouble sleeping, changes in appetite, stomach pain, and diarrhea. Most of these side effects are mild and get better over time. We start medications at a low dose to help minimize these side effects. It's normal to worry about side effects. Side effects are important to consider when deciding if a dose needs to be adjusted. Sometimes, it can be hard to tell if a symptom is a side effect of the medication or anxiety about taking the medication, like a stomachache.

The FDA has added a "boxed warning" to all antidepressant medications to alert doctors and patients about the need for special care when these medications are used in children, adolescents, and young adults. This warning states that antidepressants are linked to an increased risk of suicidal thoughts and behavior in a small number of children and teens, especially at the beginning of treatment.

Research shows a slight but notable increase in the risk of suicidal thoughts and behaviors among children and teens taking SSRIs. However, in research studies, this did not lead to actual suicide deaths. Studies also show that kids who are in therapy do not have this increased risk. While the current evidence does not definitively prove a clear link between antidepressants and these increased risks, the benefits of treating depression generally outweigh the potential risks.

It is crucial to monitor your child closely if they are on an antidepressant. Pay careful attention to any changes in mood, behavior, thoughts, or feelings, especially when starting a new medication or adjusting the dose. Watch for any sudden changes, as these can indicate increased risks and may need immediate action. By closely observing and reporting these changes, you can help ensure your child's treatment is safe and effective.

No, the medications prescribed by our providers are not habit-forming. Your child will not become physically or emotionally dependent on them. These medications help reduce symptoms of depression, but they are just one part of the treatment. When medication & psychotherapy/counseling are used together, they offer the maximum benefit.

Medications can help shape your child's personality over time in a positive way. They reduce symptoms of depression, which can lead to more positive feelings, thoughts, and behaviors. When your child feels happier, they start thinking more positively and start engaging in activities they might have previously avoided. Participating in positive activities helps boost their self-confidence, which in turn promotes even more positive behavior. This creates an upward cycle of improvement. These positive changes show that the medication helps your child feel and function better without changing who they are.

You will know that the medication is working if you notice these improvements in your child:

• They seem to be happy and enjoying life more.
• They start enjoying activities again in which they lost interest in.
• Their energy and motivation improve.
• They are not isolating themselves anymore.
• Their eating and sleeping get better.
• Their overall well-being and confidence improve.
• They are not as self-critical or negative about themselves.
• Their schoolwork, relationships, and activities get better.

Once your child's symptoms of depression have been gone for 12 months, the medication can be slowly reduced and eventually stopped. This process usually takes 3 to 6 months, depending on the dose. Higher doses might take longer to taper off. Any tapering and stopping should be done under the supervision of a licensed specialist to ensure safety and effectiveness.

Here are a few things to remember:

• Long-term use of these medications is safe if the medication is well-tolerated.
• There's a risk that depression could return even after your child has recovered if medications are discontinued.
• Children who have learned how to manage their depression in therapy are less likely to have symptoms come back once the medication is stopped.
• If depression returns after stopping the medication, it may be necessary to continue the medication indefinitely.

Children with depression often have trouble sleeping. Good sleep habits, known as sleep hygiene, can help all children with sleep issues. If these habits don't help, your provider may prescribe medications to help your child fall asleep and stay asleep.

Melatonin is often the first treatment used. Some antidepressant medications like Trazodone and Mirtazapine can also help with sleep problems related to depression. Hydroxyzine (Atarax or Vistaril) can also be helpful. Clonidine can be effective, especially if your child also has ADHD. 

These medications should only be taken as prescribed by your provider to ensure they are safe and effective for your child.

Approach conversations with empathy and patience. Ask open-ended questions to encourage sharing. Listen actively, showing that you understand and care. Avoid being critical or dismissive. Let your child know it’s okay to feel the way they do and that you are there to support them.

Discuss their concerns openly and involve them in treatment decisions, understanding their fears to help address them. Emphasize the benefits of medication in managing anxiety and improving quality of life. Use the DESC technique to communicate effectively and foster cooperation—click here for a guide on implementing this method. If necessary, consult their healthcare provider to explore alternative treatment options.

Maintain regular communication with your child, their teachers, and school counselors to understand how anxiety affects their school functioning. If depression is impacting your child, discuss with their provider and counselor whether school accommodations would be helpful. If recommended, work closely with school staff to develop an individualized education plan (IEP) or 504 plan. Ensure the school provides the necessary accommodations. Being proactive helps create a supportive school environment.

Consult with a healthcare provider to determine if homeschooling is appropriate. In most cases, homeschooling can make depression worse. Avoiding school can reinforce negative thoughts like "no one likes me" or "no one wants to be friends with me," leading to more depression. However, in some situations, homeschooling can be a temporary solution. If your child's provider recommends this and you choose this route, work towards gradually reintroducing your child to a school environment. Collaborate with your child's therapist and school staff to create a transition plan for when your child is ready to return.