Depression in children

All children "feel blue", from time to time, have a bad day, or are sad. However, when these feelings persist and begin to interfere with a child's ability to function in daily life, clinical depression could be the cause.

Depression is a serious mental health problem that affects people of all ages, including children. In fact, depression affects as many as one in every 33 children and one in eight adolescents.

Depression can lead to academic underachievement, social isolation, and create difficult relationships with family and friends. Depression in children is also associated with an increased risk of suicide. It has been estimated that more than 90% of children and adolescents who take their lives have a depressive illness. The risk is greatest among adolescent boys if accompanied by alcohol or substance misuse. In addition to this, depressive disorders are associated with an increased risk of physical illness and relationship and social difficulties that persist long after the depressive episode.

Depression in young people often occurs with other mental disorders, most commonly anxiety, disruptive behaviour or substance abuse disorders, and with physical illnesses, such as diabetes. Once a young person has experienced an episode of depression, s/he is at an increased risk for having another episode of depression within the next five years. Children who experience a depressive episode are five times more likely to have depression as an adult.

For more general information about this condition, see the Depression  section.

Causes of depression in children

No one thing causes depression. Children who develop depression may have a family history of the illness. Family history, stressful life events such as losing a parent, divorce, or discrimination, and other physical or psychological problems are all factors that contribute to the onset of depression. Children who experience abuse, neglect, or other trauma or who have a chronic illness are at a higher risk for depression. Depression in children often occurs along with other mental health problems, most commonly bipolar disorder or disruptive behaviour disorders. Adolescents who become clinically depressed are also at a higher risk of substance misuse.

There are other factors which can increase the risk of depression for children and adolescents:

  • stress
  • cigarette smoking
  • a loss of a parent or some one they love
  • break-up of a romantic relationship
  • attentional conduct or learning disorders
  • chronic illnesses, such as diabetes
  • abuse or neglect
  • other trauma, including natural disasters

In general, medication should be considered as a first-line course of treatment for children and adolescents who have severe symptoms that would prevent effective psychotherapy; those who are unable to undergo psychotherapy, those with psychosis, and those with chronic or recurrent episodes.

Following remission of symptoms, medication and/or psychotherapy should be continued for at least several months given the high risk of relapse and recurrence of depression.

Treatment of depression in childhood

Depression is treatable. Early identification and treatment helps children reach their full potential. Children who show signs of depression should be referred to and evaluated by a doctor and preferably referred to a child psychiatrist. The assessment may include psychological and medical tests to rule out any underlying conditions that might explain the child's symptoms.

Treatment for depressive disorders in children and adolescents often involves short-term psychotherapy, medication, or the combination, and targeted interventions involving the home or school environment.

Psychotherapy
Recent research shows that cognitive behaviour therapy (CBT) can help relieve depression in children and adolescents leading to remission in 65% of cases. Interpersonal therapy has also been shown to be effective in the treatment of depression.

Continuing psychotherapy for several months after remission of symptoms may help children and families pull together the skills they have learned during the acute phase of depression to cope with the after-effects of depression, recognise environmental stressors and understand behavioural and thoughts that could contribute to a relapse.

Medication
Research clearly demonstrates that antidepressant medications, especially when combined with psychotherapy, can be very effective treatments for depression in adults. However, there has recently been much controversy about the use of antidepressants for children and adolescents. The concern centres on the ability of some newer selective serotonin reuptake inhibitors (SSRI’s) to cause self harming and suicidal behaviours in children.