Depression in Children and Teenagers
Child Depression and Teenage Depression
Depression in Children and Teenagers
Children and teenagers can experience depression just as adults can. But
children go through so many ups and downs in the normal course of
childhood that it isn’t always easy to tell the difference between a
temporary “stage” and a problem that needs attention. It’s natural for
your child or teenager to feel sad or anxious at times -- for example, when
a grandparent dies or a best friend moves away. These feelings usually
become less intense after a while, and your child bounces back and begins
to seem like herself again. But if your child has been feeling sad for a long
time or seems to be having much more difficulty than usual, these changes
in behavior may be signs of depression. A mental health professional or
your child’s physician may be able to help you identify the problem and
suggest ways to help your child.
Signs of depression
The following signs of depression to watch for in children:
• Your child seems “down.” Does your child show little interest in activities he used
to enjoy? Has he stopped seeing friends? Does he never seem to leave his room?
These can be signs that your child or teenager is depressed. Although every child
feels sad from time to time, the situation may be more serious if the sadness
persists for more than a month and is interfering with sleep, time with peers,
daily activities, or your child’s enjoyment of life.
• Changes in appetite, including weight loss or gain. Does your child want to eat
constantly, even if she has just finished a meal? Has she lost her appetite, eating
very little at mealtimes? Has she stopped eating favorite foods?
• Sleep problems, including sleeping too much or having trouble sleeping. Is your child
taking naps despite getting a good night’s sleep? Is he awakening early in the
morning and having trouble going back to sleep? Is he constantly complaining
about being tired?
• Complaining. Your child or teenager may show that she’s depressed by
complaining, particularly about health problems that seem to have no physical
cause. She may have headaches, stomachaches, and other vague “aches and
pains,” and she may miss school frequently.
How you can help a child
or teenager who is
• Signs of depression
• What you can do to help
• If your child or teenager
talks about dying
• What causes depression?
• Various kinds of treatment
• Questions to ask a
• Helping your child 2 z Depression in Children and Teenagers
• Trouble getting along with others. Difficulty with peers can be a sign of depression.
A child or teenager who is picked on, teased, or excluded, or who feels the need
to be a bully and pick on others, may be depressed and need help.
• Problems with schoolwork. A common sign of depression in children is trouble with
schoolwork. Your child may be getting lower grades, neglecting his homework,
or not completing projects. These may be signs that he is having trouble paying
attention. He may be worrying about something, which is keeping him from
doing his best work. Particular attention should be paid to children who are
usually “good students” but who suddenly seem to be having trouble in school.
• Crying more than usual. A child who seems to cry easily and without the usual
provocation may be demonstrating signs of depression.
• Social isolation. Avoiding friends and becoming socially isolated can be a sign of
depression. Cutting off relationships that were important in the past can also be a
sign of depression.
• Watching more television or playing more video games. A desire to watch TV or play
video games instead of participating in other activities that your child once
enjoyed could be a sign of depression.
• Giving away belongings and making statements about what she wants to happen to her
things should something happen to her.
• Preoccupation with death, particularly with asking about what happens after death.
• Causing physical harm to oneself. Some teenagers who are depressed may cut their
arms or other body parts. Act promptly if this is noted, to avoid other physical
What you can do to help
When you see signs of depression, you can help by talking with your child,
listening carefully, and getting help with problems that don’t go away. Here are
some steps you can take:
• Ask questions. Try to find out what is making your child feel sad and how often
she feels that way. If your child has become withdrawn and resists answering
questions, you may be able to draw him out by showing that you understand
through comments like, “You seem to have been very sad since Joshua moved
away. You must miss him a lot.” Let your child know that you care and want to
help. If your child does not seem to be opening up to you, enlist the help of a
family member, friend, or teacher with whom your child feels comfortable.
• Don’t assume your child or teenager will “outgrow” the problem. Hoping that signs of
depression will go away can increase your teenager’s frustration. If she has been
trying unsuccessfully to feel better on her own, letting the problem go on could
make your child feel guilty. She may be blaming herself for problems that aren’t 3 z Depression in Children and Teenagers
her fault. Children and teens do not have the coping skills and life experiences
that help many adults to cope with such situations.
• Understand that depression is treatable. If you seek help promptly after noticing
signs of depression, you may be able to keep your child’s depression from
• Realize that depression doesn’t just go away. Depression may be related to a chemical
imbalance and, even if a situation that triggered depression has improved, your
child may still require treatment.
• Talk to your child or teenager about counseling. Your child or teenager may not
understand that there are people he can talk to when he feels unhappy who can
help him find solutions to his problems. Let him know that he doesn’t have to
keep all his feelings inside. If your child or teen resists counseling, suggest a
short-term contract for a limited number of visits, giving the physician or
therapist a chance to break through the depression. You may find that your child
will be more interested in continuing once he starts to feel a little better.
• Let an older child or a teenager participate in counseling decisions. You’ll have to make
decisions for a younger child. But if you let an older child know about some of
the counseling options that exist, she may want to participate in the decision or
suggest the kind of counselor she would feel most comfortable seeing. If possible,
let her choose whether to see a male or female therapist.
• If your child refuses counseling, go yourself. A therapist may be able to work with you
to help your child or teen indirectly.
• If necessary, be willing to involve your entire family in counseling. Each child or
teenager lives within the context of a family, and behavior is often shaped by the
family dynamics. Family therapy can benefit your child, directly or indirectly.
• Be sure to involve both parents whenever possible with counseling and medication
decisions. Both parents need to support such decisions. Children and teens often
“play” one parent against the other with everyday issues. If a child understands
that his parents are in agreement and will not back down, he is more likely to be
willing to seek help and follow a therapy program.
If your child or teenager talks about dying
It’s always upsetting and alarming to hear your child or teenager say something
like, “I just feel like killing myself.” This can be a sign of severe depression, so it’s
important not to ignore comments like these. Take these steps right away:
• Take the comment seriously. Think about what your child has said and how it fits
into other things that are happening in her life. Don’t ignore it or shrug it off as a
figure of speech, especially if your child has been feeling low for awhile. 4 z Depression in Children and Teenagers
• Talk with your child or teenager. Talk with your child as soon as you can about
what he said. Does he sometimes think seriously about hurting himself? If so, try
to find out what is making him feel so sad and what you can do to help.
• Show that you want to help. Try not to brush off remarks about death with phrases
like, “You’re just going through a phase,” or, “Tomorrow you won’t even
remember how upset you were.” This may make your child think you don’t care
about her pain. Try to show that you understand how sad she feels.
• Keep a watchful eye on your child. Look for other signs that your child or teenager
may be serious about hurting himself. For example, children who are thinking
seriously about death often start giving away their favorite possessions.
• Suicide-proof your home. Be sure that any guns are removed from the home or
make sure that they are locked unloaded, with the ammunition stored separately.
Your child or teen should not have access to them at any time. Medications
(including over-the-counter medications like ibuprofen and acetaminophen)
should be inaccessible at all times. This should also include any medicines for
depression. Finally, make sure that knives and razor blades are kept in an
• Seek professional help. If you’re unsure about how serious the problem is, a
counselor can evaluate the situation and help you decide what to do next. Don’t
assume that the sad feelings are trivial or that they will go away on their own.
Even if the problem turns out not to be serious, talking to a counselor can help
you understand how to keep it from getting worse. Call the National Suicide
Prevention Lifeline at 800-273-TALK (800-273-8255) if you need help
immediately for a child or teenager who may be at risk for suicide.
• Don’t be fooled by a sudden improvement in mood. Recovery from depression is
seldom quick. If your child has been showing signs of depression and suddenly
becomes upbeat, do not assume that the depression has passed. This could
actually be a sign that the child has made a decision and will act soon to harm
herself. Seek professional help to assess the situation.
What causes depression?
Depression can have many causes in children or teenagers. Usually it results from
a number of factors that work together to create a situation that makes your child
feel that he can’t cope. Many doctors believe that depression generally results
from a combination of hereditary and environmental factors. A family history of
depression can increase the risk that someone will experience the condition, but
depression can also occur in children with no history of depression in their
families. The common causes of depression include the following:
• Stress. Your child may have become depressed because she believes she has to be
perfect, and she blames herself for not being able to live up to her own or other 5 z Depression in Children and Teenagers
people’s expectations. She may also be having trouble handling a heavy load of
schoolwork or adjusting to a big change, such as a divorce in the family.
• Loss. Children and teenagers often show signs of depression after losing the love
or affection of someone they depend on -- a parent or another relative, a
caregiver, or a special teacher. They may also become depressed when a romance
ends, when they move to a new home, or when a close friend moves away.
• Chronic illness. Depression can occur along with some chronic or serious illnesses,
such as diabetes or cancer that make your child feel afraid or “different.” This
kind of depression can often be treated along with the illness.
• Biological changes. The normal biological changes of adolescence can make your
child feel upset or confused about what is happening to his body. These changes
can be especially unsettling if your adolescent is also coping with other changes,
such as starting a new school or facing intense peer pressure.
Various kinds of treatment
A professional evaluation can help you decide whether your child or teenager is
depressed and, if so, what treatment would be best. Your pediatrician or family
doctor can refer you to someone who can help -- a psychiatrist, psychologist,
social worker, or another professional counselor. You might also be able to get
recommendations from family and friends, a guidance counselor, or a religious
leader you trust. After evaluating your child, a counselor might suggest treatment
that includes psychotherapy or another form of therapy, medication, or both.
• Psychotherapy, or “talk therapy.” In this kind of therapy, your child talks with a
professional who can help her understand and find ways to cope with things that
are bothering her. Psychotherapy gives your child a safe place to talk about the
feelings of loss, sadness, or frustration that may be contributing to her
depression. Psychotherapy may or may not involve other members of the family.
• Play therapy. Play therapy is a form of talk therapy designed for younger children
or for children who have other problems, such as difficulty putting their feelings
into words. In play therapy, a therapist might use dolls, toys, or games in working
with your child. A related form of therapy known as art therapy encourages
children to express their feelings through drawings and paintings.
• Medication. Antidepressant medications are designed to help people feel better by
acting on the chemical pathways in the brain related to moods. Medical research
has shown that a variety of antidepressants can be effective for adults, but the
results are less clear for children and teenagers. And studies have shown that
antidepressants can increase the risk of suicidal thoughts and behavior in young
people. For this reason, any child or teenager who is taking antidepressants needs
to be monitored closely by his doctor and his caregivers for signs that he may be
feeling more depressed. Some doctors believe antidepressants should be used
with psychotherapy or to help young people make enough progress to continue 6 z Depression in Children and Teenagers
with talk therapy. You can learn more about the effects of antidepressants on
children and teenagers by visiting the Web site for the U.S. Food and Drug
Administration (FDA) at www.fda.gov.
Questions to ask a therapist
If you decide to have your child evaluated by a counselor or therapist, you’ll
probably want to ask a lot of questions about your child and the recommended
treatment. Questions to ask include the following:
• Is my child depressed?
• How serious is the depression?
• Do you recommend psychotherapy?
• Are there support groups for parents who are coping with this kind of condition?
• How can I find those groups?
If a doctor recommends medication for your child, ask the following questions:
• What kind of medication is needed?
• How long will the medication be needed?
• What are the side effects?
• How long will the side effects, if any, last?
• How will the medication interact with other medications that my child might be
taking, such as ibuprofen or cough syrup?
• Is this medication approved for use with my child’s age group?
• If not, why do you believe it might still be beneficial?
• Are there any alternatives to this medication?
• How will you monitor my child while she is taking this medication?
• How do my child’s caregivers and I need to monitor my child at home?
• Has the FDA approved this drug for the use for which you are prescribing it? Or
are you recommending an off-label [unapproved] use? If so, why are you
recommending the off-label use?
• Do you have any suggested books, Web sites, or other resources for more
Helping your child
You can help your child cope with depression by paying close attention to his
feelings and needs. 7 z Depression in Children and Teenagers
• Make time for your child or teenager. Try to set aside some time each day to talk
with your child.
• Keep the lines of communication open. Your child or teenager needs to feel free to
talk to you about anything that is bothering her. Try not to get angry or upset if
she expresses a view that upsets you or is very different from yours.
• Respect your child’s privacy. Let your child or teenager know that you care about
him, but won’t force him to talk about a subject if he isn’t ready. Show that you
respect his privacy about subjects that might be too painful to talk about now.
• Watch for signs of depression. For example, watch for changes in your child’s
sleeping or eating habits, for unusual problems with schoolwork, or for signs that
your child has stopped seeing friends and is spending more time than usual alone.
• Encourage good habits. Good health and social habits can make your child or
teenager feel better even if she is depressed. Help your child find ways to get
regular exercise and enough sleep, eat a balanced diet, and stay in touch with
friends and family. Encourage her to participate in activities such as a club, youth
group, or volunteer organization where she can meet others with similar
Depression in children and teenagers isn’t always easy to identify or overcome,
but there are many effective ways to treat it. You can learn more about treatment
options by visiting the Web site for the National Institute of Mental Health at
www.nimh.nih.gov. The key to finding the kind of help your child needs is to be
willing to try a variety of approaches until you find the one that works best.
For help and support, remember that the program that provided this publication
has many helpful resources.
This information is provided to supplement the care provided by your physician and is not to be used
as a substitute for professional medical advice. Always seek the advice of your physician or other
qualified health provider if you have questions about a medical condition or plan of treatment.
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