Major Depression in Children and Adolescents

This is one of a series of fact sheets on the mental, emotional, and behavior disorders that can appear in childhood or adolescence. The Center for Mental Health Services extends appreciation to the National Institute of Mental Health for contributing to the preparation of this fact sheet. Any questions or comments about its contents may be directed to SAMHSA’s National Mental Health Information Center-see contact information below.
What Is Depression?

Major depression is one of the mental, emotional, and behavior disorders that can appear during childhood and adolescence. This type of depression affects a young person’s thoughts, feelings, behavior, and body. Major depression in children and adolescents is serious; it is more than “the blues.” Depression can lead to school failure, alcohol or other drug use, and even suicide.

What Are the Signs of Depression?

Young people with depression may have a hard time coping with everyday activities and responsibilities, have difficulty getting along with others, and suffer from low self-esteem. Signs of depression often include:

  • sadness that won’t go away;  
  • hopelessness;  
  • loss of interest in usual activities;  
  • changes in eating or sleeping habits;  
  • missed school or poor school performance;  
  • aches and pains that don’t get better with treatment; and thoughts about death or suicide.

Some young children with this disorder may pretend to be sick, be overactive, cling to their parents and refuse to go to school, or worry that their parents may die. Older children and adolescents with depression may sulk, refuse to participate in family and social activities, get into trouble at school, use alcohol or other drugs, or stop paying attention to their appearance. They may also become negative, restless, grouchy, aggressive, or feel that no one understands them. Adolescents with major depression are likely to identify themselves as depressed before their parents suspect a problem. The same may be true for children.

How Common is Depression?
Recent studies show that, at any given time, as many as 1 in every 33 children may have depression. The rate of depression among adolescents is closer to that of depression in adults, and may be as high as one in eight.2

Having a family history of depression, particularly a parent who had depression at an early age, also increases the chances that a child or adolescent may develop depression. Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next 5 years. This young person is also at risk for other mental health problems.

What Help Is Available for a Young Person with Depression?
While several types of antidepressant medications can be effective to treat adults with depression, these medications may not be as effective in treating children and adolescents. Additional research is needed to determine whether antidepressants are useful in helping young people. Researchers also are concerned about the potential severe side effects of these medications.

Some success has been reported recently with a drug called Fluoxetine. Fluoxetine seems to have fewer side effects than other antidepressant medications. However, care must be used in prescribing and monitoring all medication.

Many mental health care providers use “talk” treatments to help children and adolescents with depression. The National Institute of Mental Health has made it a priority to evaluate the effectiveness of the following types of therapy:

  • individual psychotherapy;  
  • family psychotherapy;  
  • and group therapy.

A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions.

Tying together all the various supports and services in a plan of care for a particular child and family is commonly referred to as a “system of care.” A system of care is designed to improve the child’s ability to function in all areas of life-at home, at school, and in the community.
What Can Parents Do?

If parents or other important adults in a child’s or teenager’s life suspect a problem with depression, they should:

  • Make careful notes about the behaviors that concern them. Note how long the behaviors have been going on, how often they occur, and how severe they seem.  
  • Make an appointment with a mental health professional or the child’s doctor for evaluation and diagnosis.  
  • Get accurate information from libraries, hotlines, or other sources.  
  • Ask questions about treatments and services.  
  • Talk to other families in their community.  
  • Find family network organizations.

Provided by ArmMed Media
Revision date: June 11, 2011
Last revised: by Janet A. Staessen, MD, PhD