Depression in Children
Depression is a common mental heath condition characterized by changes in mood, behavior, and functioning that persists for at least several weeks and causes difficulties in daily living. For children this might mean academic or behavioral issues at school, difficulties interacting with peers, or withdrawing from family. Depression is more than simply being in a bad mood, feeling sad, or having a negative attitude and includes other significant psychological, biological, and behavioral changes.
Depression Symptoms in Children
Frequent mood swings
Academic difficulties (e..g, drop in grades, not doing school work)
Behavioral issues (e.g., getting into trouble at school, or school refusal)
Change in appetite
Loss of energy or fatigue
Thoughts of death or suicide
Depression Treatment for Children
Cognitive-behavioral therapy (CBT) is the most researched and scientifically proven psychotherapy for treating depression in children. CBT is a very practical and easy to understand treatment approach that emphasizes the here-and-now and the development of effective coping skills and strategies. In children, more emphasis is typically placed on behavioral interventions than on the development of insight.
Psychotherapy (i.e., talk or behavioral therapy) is an effective treatment for depression in children. For mild to moderate depression psychotherapy is recommended as a first-line treatment. For more severe cases of depression a combination of medication and psychotherapy is typically recommended.
Family therapy is also commonly recommended for children who might be depressed. Family therapy aims to help parents and caregivers learn how to more effectively provide support and create a less stressful environment for the child. Individual therapy with children is more effective when parents and/or caregiver take an active role in treatment.
Certain medications (i.e., SSRIs) are commonly used to treat depression in children and like psychotherapy have been proven to be effective. While the use of medication to treat depression in children has grown steadily over the past couple of decades there remains concern regarding the safety of some medication use in children. For more information regarding the use of medications in treating depression in children click here to visit the NIMH website on the matter.
Depression Therapists for Children
Depression is a condition that can affect a child’s ability to connect with friends and family, enjoy normal daily activities, attend and concentrate in school, and enjoy childhood. Proper diagnosis and a treatment plan with a licensed therapist is a good start; but it helps to know what to expect during the process and what you can do to be helpful.
Understand the symptoms
Most people think that recognizing depression is obvious. It would look like tearfulness & open saddness. For children, the defining feature of a major depressive episode is usually irritability. It is important to watch for these other symptoms as well:
- Saddness, withdrawn, or stating they are bored most of the time. This is most noticeable when children are avoiding those things they usually find interesting.
- Not taking pleasure in usual activities. Complaining about having to participate.
- Sleeping too much or too little. This would mean whatever is not normal for them.
- Weight gain or weight loss. Children can hit growth spurts which can mask weight change. Look for refusal to eat or excessive snacking.
- Feeling hopeless or helpless. Whining or acting infantile (sucking a thumb, carrying a security item) can indicate feelings of being overwhelmed.
- Difficulty concentrating or making decisions. Depression clouds our judgement, so look for things that your child usually can handle on their own that they might be coming to you to fix for them (ie. find lost items, help them study).
- Fatigue. Children usually have boundless energy. When children are falling asleep earlier than usual or sleeping for longer periods of time, it could be depression.
- Thoughts of death or suicide.
What to expect from treatment
Treatment for a depression can take time and sometimes involves trial and error. No two kids are the same, and it’s important to remain patient with the process to help your child feel safe.
- Education: Educating your child and yourself about depression is a crucial first step. This helps your child understand the possible causes (genetics, environmental factors, bullying, stress, etc.), understand brain chemistry (low serotonin), and reduces self-blame. It also normalizes what your child is going through and that they are not broken or wrong.
- Psychotherapy: Counseling is a good option for kids struggling with depression. There are different kinds of counseling and what works for one might not work for another. For very young children, play therapy is an option. For older kids and teens, Cognitive Behavioral Therapy (CBT) can be effective. It can take time to find the best patient/therapist match. Don’t be afraid to ask questions. You know your child best.
- Medication: Medication might not be necessary for most cases, but medication works best when combined with counseling. Medication management is important. Close supervision of the prescribing physician is recommended.
- Hospitalization: For severe cases of depression, including suicidal ideation, hospitalization is sometimes necessary.
What to expect at home
Even with medication, there is no quick fix for depression. Treatment can seem long and slow going. Parents can help support children by doing the following:
- Encouraging daily exercise (this does not have to include an organized sport. Family walks count.)
- Supervising any medication (it’s too much to ask a depressed child to manage his own medication).
- Make time to talk. Counseling will help your child begin to open up and verbalize feelings; it’s your job to listen and provide unconditional support when your child opens up at home.
- Cook healthy meals. Healthy lifestyle choices can help with the treatment process. Protein rich foods promote energy, while junk food often leaves children “crashing” emotionally which can exacerbate symptoms.
- Encourage healthy sleep habits. Most of us need at least 8 hours for our bodies to recoup for the next day. Most children need at least 9-10 hours to do the same. Make sure you are providing a tranquil sleeping environment which may include background sounds (white noise) or cooler temperatures that encourage bodies to sleep. Also make bedtime a consistent time each night. Structure and routine are important for healthy development.
What to expect at school
It’s difficult to perform well in school when thinking and concentration are impaired by depression. It’s important to include the classroom teacher and a school counselor on the treatment team to help your child work through this difficult time.
Classroom accommodations might benefit your child during this time. Talk to the classroom teacher about the following:
- Extended time for lengthy assignments and tests
- Breaking down assignments into manageable pieces (this is particularly helpful for kids who appear “overwhelmed”)
- Help to create study or homework schedules
- Provide a copy of class notes (helpful for impaired concentration)
- Taking tests in a quiet room, free from distractions
It’s also helpful to have a plan in place should your child need a break during the day. Examples might include a daily check-in with a school counselor in the early stage of treatment and a weekly appointment with their therapist as your child stabilizes.
What to expect from your child
Children are not mini-adults. They are developing and changing at a rapid pace, even when they experience a depressive episode. Symptoms can intensify and lessen throughout treatment. You might find that the depression seems to have lifted, only to notice a relapse in depressive behavior a few days later.
Irritability, feeling overwhelmed, and outbursts are common in depressed children. As hard as this can be for the parent on the receiving end of these behaviors, it is important that parents remain calm and focus on active listening. It’s the natural tendency for a parent to want to “fix” it or somehow put a stop to it. It can’t be fixed or stopped. It can, however, improve. With proper treatment and supports in place, your child can thrive and enjoy childhood once again.