Young Depression

Depression in children and teens

/ Author:  / Reviewed by: Robert Carlson, M.D

Depression is sometimes thought of as an adult disorder, perhaps something that strikes as the challenging realities of adult life come into play. However, this way of thinking about depression is inaccurate and outdated.

Although the risk of depression does increase as children age, the National Institute of Mental Health (NIMH) reports that around 11 percent of adolescents have a depressive disorder by the time they are 18.

Views about childhood depression are changing and because of this, new treatments and programs are developing on the horizon and new research is attempting to better understand the differences between adult and childhood depression.

Signs and Differences

According to NIMH, “Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child who shows changes in behavior is just going through a temporary 'phase' or is suffering from depression.”

To complicate the issue, while the disorder is still the same at its core, depression in children may express itself differently than it does in adults.

However, the National Alliance on Mental Illness (NAMI) reports there are signs that may signal that depression may be at play, including persistent sadness or if a child suddenly becomes extremely irritable.

Depressed children may show a decline in functioning both at school and at home, and they may complain of physical ailments or problems. Often this results in many visits to school nurses.

According to NIMH, “Children who are depressed may complain of feeling sick, refuse to go to school, cling to a parent or caregiver, or worry excessively that a parent may die.”

They may also withdrawal from friends or not want to participate in activities they used to enjoy.

In teens, depression may show up as sulking, negativity, feelings of being misunderstood, or getting into trouble and acting out at school.

According to NAMI, depressed children or adolescents may talk about suicide or “being better off dead.”

Substance abuse may also be an issue for these adolescents, which would also need to be addressed in treatment for depression.

Treating Carefully

In treating these young patients, some studies show that a combination of both prescription medication and psychotherapy may be the best option for depressed children and adolescents.

NAMI reports that both cognitive behavioral therapy (CBT), which works to mold negative perceptions, and interpersonal therapy (IPT), which deals with relationships and self-perceptions, have shown to be effective for children and adolescents. 

Antidepressants (either on their own or in combination with talk therapy) can also help young patients with depression, however, it can be a tricky area and risks are present.

According to NIMH, "Although antidepressants are generally safe, the US Food and Drug Administration has placed a “black box” warning label—the most serious type of warning—on all antidepressant medications. The warning says there is an increased risk of suicidal thinking or attempts in youth taking antidepressants."

NAMI reports that fluoxetine (or Prozac) is the only antidepressant medication specifically approved by the FDA to treat depression in children. Doctors may still sometimes prescribe other medications, but it is always important to discuss prescriptions carefully.

Regardless of the plan of action taken, it is important to make sure that the patients themselves are involved in treatment decisions and that a good support system is created to assist them as they cope with this disorder.

Changing Views and a Look Ahead

In years past, when the idea of childhood depression was not a commonly accepted one, “teens with depression were often dismissed as being moody or difficult,” according to NIMH.

Thankfully, this is no longer the case, and research to explore depression in youth has allowed both doctors and the public to understand more. As research continues, it seems likely that treatments for childhood and adolescent depressions will continue to grow and develop.

In fact, NIMH reports that "years of basic research are now showing promise for the first new generation of antidepressant medications in 2 decades, with a goal of relieving depression in hours, rather than weeks. Such a potential breakthrough could reduce the rate of suicide, which is consistently one of the leading causes of death for young people."

Developments in new ways of delivering treatment - like services being provided over the internet or satellite connections - are also changing the ways in which youth could potentially access treatment for depression in the future.

Furthermore, NAMI reports that “Preschool depression has begun to attract interest in the literature but much more needs to be learned about how mood disorders may affect this age group.”

Time will tell exactly how these changes and new areas of research will develop into methods of helping children and adolescents with depression. As old belief systems are molded and more and more is understood, the better these youth can be treated and supported.

Reviewed by: 
Review Date: 
November 28, 2012