Depression in Children and Youth: Information for Parents and Caregivers

Summary: It is normal for children and youth to feel sad (as well as angry and irritable) from time to time, but when these moods are so severe that it causes problems, it may be depression. Recognizing depression is extremely important because getting help early on makes a difference, and helps prevent childhood depression from becoming adult depression.
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What is depression?

It is normal for children and youth to feel sad from time to time.  But this sadness doesn’t stop them from going on with their everyday activities.  And it goes away on its own.  Depression, on the other hand, is a sadness so severe that it interferes with everyday life.  

Typical symptoms of depression (aka clinical depression, or major depressive disorder) are:

  • Feeling sad, worried, irritable or angry
  • Lack of enjoyment in life, or troubles enjoying anything
  • Feeling hopeless and worthlessHaving troubles coping with everyday activities at home, school, or work
  • Problems with sleep, energy, appetite and concentration

With severe depression, a person may even hear voices, or have thoughts of harming themselves or others. Depression is more than normal sadness.  A depressed person can’t ‘just snap out of it’.  Studies even show actual, physical changes in a person’s brain when they have a clinical depression.

How common is depression?

Depression is common.  Researchers believe that about 1 in 5 children and youth will go through a depression by the time they turn 18.  Studies also tell us that at any one moment, between 4 and 8 out of every 100 children and youth are having a major depression.  Sadly, most people with depression do not get help.  But getting help is important, because there are effective treatments, and early treatment can stop it from coming back in the future (AACAP, 2007).

What causes depression?

Sometimes parents feel guilty that they caused their child’s depression. There is usually not one single cause, but rather a combination of different things going on at the same time:

  • Family history: If parents or other members of your family have had depression or other emotional problems, there is a bigger chance that your child or teen may have depression.
  • Stress: Children and youth can get very upset by…
    • Conflicts between parents, and any brothers/sisters
    • Parents coping with stress or depression
    • Parent’s separation or divorce
    • Bullying
    • Conflicts or stresses with friends or classmates
    • Not doing well in school or feeling too much pressure to do well in school

It can be hard for adults to see things from a child or teen’s point of view. Things that might not seem to be a big deal to an adult can be overwhelming to a child or youth.  And some children are just more sensitive to stress.

What should we do if we think our child is depressed?

If your child had a broken arm and was in pain, you’d take her to a doctor, right?  Instead of causing pain on the outside, depression causes pain on the inside.  But you still need to help your child with this pain.  If you think your child might be depressed, start by taking him to a doctor (like your family doctor or pediatrician), and describe the changes you’re noticing in his behaviour and feelings.  The doctor can check for medical problems that might be causing the depression.  The doctor may suggest mental health services, and can help you link with psychologists, psychiatrists or social workers.

If you are worried that your child may hurt himself or herself, call:

  • Your child’s doctor
  • Emergency department, or a
  • Crisis line

If you suspect depression

If you suspect that your child/youth has depression, have him/her seen by a doctor (such as a family physician or paediatrician) to make sure there aren't any medical problems (such as hormone imbalances) that might be causing or contributing to the depression. The doctor may recommend more specialized mental health services, or help with referrals to mental health professionals such as a psychologist, psychiatrist or social worker.

 

* If you are concerned that your child may be having thoughts of suicide, then consider contacting a crisis line and/or a local hospital emergency room.

How is depression treated?

Many different treatments are available for depression. They can be used alone or together, depending on your child.  Some treatments work well with some children, but not with others.  If a treatment isn’t working (after giving it a good try, of course), your mental health professional may talk with you and your child about trying something else.

 

“Talk Therapy” or Psychotherapy

There are different types of talk therapy, which include (but are not limited to):

  • Cognitive behaviour therapy (CBT):Helps individuals cope with depression by focusing on changing their thoughts and behaviours. In depression, individuals tend to have negative, depressive thoughts. In CBT, individuals learn to replace depressive thoughts with more positive, helpful thoughts.
  • Interpersonal psychotherapy (IPT): Helps with depression by focusing on improving relationships. Regardless of how the depression started, individuals with depression tend to have tension in their relationships from either 1) conflict or withdrawal, or 2) life transitions or changes. IPT helps improve these difficulties.
  • Solution-focused therapy: Helps by finding solutions. In depression, individuals tend to focus on life stresses and problems. In solution-focused therapy, individuals get support in finding solutions to these difficulties.

Medications

 

May be helpful in certain cases, and these may be prescribed by a family physician, paediatrician or psychiatrist. Medications are generally used only when other treatments have not been successful, or when the depression is so severe that other treatments are not possible.

 

There have been concerns about the safety of antidepressant medications in children and youth. Current research shows that when used in the right way and monitored by a physician, antidepressants are safe and effective (Bridge, 2007). Like prescription eyeglasses, medications must be chosen and adjusted for each child or youth.  

Some people have strong views about medications -- a balanced look at antidepressant treatment is the most helpful.  Medications are not all bad, but they are not needed all the time either. 

 

Outpatient and Inpatient Services

Services for depression may be provided as an “outpatient”, whereby the patient sees a mental health professional at a community agency, or a hospital clinic. For more severe depression, more intensive support and services are generally offered by hospitals such as an inpatient program. 

Helping your child who is depressed

  • Let your child know that you notice there is something wrong. "I'm noticing that you seem a bit different these days"; "You seem a bit stressed out these days"; "You don't seem yourself these days."
  • Express your concern. "I'm worried about you." "I'm scared that there might be something wrong."
  • Offer support. "Is there anything I can do to help?" "How can I support you?"
  • Make sure that you talk to your child, but find ways to still give your child choices. "We really need to talk about this - do you want to talk about it now, or later?"
  • Make sure you still have regular times when you simply have fun, relaxing times with your child. "We need to have fun times together. I have some ideas myself, but what things would you like to do?"
  • Help your child figure out what stresses s/he is under, and then help your child problem-solve ways to deal with those stresses. This usually involves a combination of reducing the stress and/or teaching the child ways to cope with those stresses. If you have an adolescent/youth, they may present as less open to your ideas. It could be more helpful to preface the discussion with "I have some ideas about managing stress that may help you, would you like to hear them?"
  • Ensure that your child is physically healthy by getting good nutrition, sleep and exercise. The Centre for Disease Control (CDC) recommends that children should get an hour of exercise over the course of each day.
  • Parents and caregivers need to remember to take care of themselves too! Make sure that you still set aside time to take care of your own personal needs. Reach out to your own support network of friends and colleagues. If you are feeling burnt out, then seek professional help for yourself. Sometimes the best way for caregivers to help those they are caring for, is to get their own help and support first.

Things to avoid doing

  • Avoid blaming or making your child feel guilty for his/her depression. This simply does not help, and just adds to the stress making your child feel even more overwhelmed. Worse, it makes your child less willing to talk with you.
  • Don't expect your child to just "snap out of it", anymore than we'd expect someone to snap out of having asthma, diabetes or other conditions.
  • Avoid getting caught into power struggles with a struggling child or youth. Give your child a sense of control by giving him/her choices whenever possible. For example, you may insist that your child needs to see a counselor, but within that, you might give them a choice over which day s/he sees the counselor, or choice over which counselor s/he sees, etc.

Healthy living makes a difference

Taking care of the basics can go a long way to helping your child or teen to feel better.  A healthy body supports a healthy mind.  Help your child to:

  • Get enough sleep.  Poor sleep can cause lower mood and energy levels.  See our fact sheet on Sleep Problems if your child or teen is having trouble sleeping.
  • Eat healthy meals and snacks, with plenty of fruits and vegetables.  Some research studies suggest that a lack of Omega 3 fatty acids can make depression worse (see our fact sheet on Omega 3 fatty acids).
  • Be physically active.  Children and youth need about an hour a day of physical activity, and it’s best if they get exercise outside in the sun.  Research tells us that aerobic exercise (exercise that increases the heart rate and breathing) can have an anti-depressant effect.
  • Get enough sunlight. Lack of sunlight (or vitamin D) can trigger depression some people who are sensitive to ‘seasonal depression’.
  • Stay away from street drugs and alcohol.  While street drugs can sometimes make youth feel better at first, they can cause more problems and make things worse after a while.

Dealing with the school

  • Speak with the school: If school stress contributes to your child’s depression, or if the depression is affecting your child at school, then it will be important to speak with the school. Make an appointment with your child’s teacher, guidance counselor or principal to talk about your child’s depression. Even if you don’t feel comfortable telling the school that your child has depression, you can at least say that your child is currently overwhelmed and having troubles with stress. It is important to work with the school to minimize any unnecessary stressors (e.g. by making accommodations or adjustments to your child’s educational plan), and at the same time, help your child cope with the stresses that s/he has.

Finding help 

In Canada, mental health services may be organized differently depending on which province or territory you live in. Nonetheless, here are some things you can do no matter where you are:

  • See a doctor: No matter where you live, one good place to start is to see your child's paediatrician or family physician who can help point you in the right direction for getting help.
  • Kids Help Phone: A national, bilingual, 24/7 hour service that any child and youth can call to talk to someone about anything that is troubling them, such as stresses at home, bullying, school, suicide and abuse. They provide a helpful professional and can help a child to get help in his/her own community through their extensive database of local resources. Tel: 1-800-668-6868. Web: www.kidshelpphone.ca.

Information about depression

Useful websites

  • The Offord Centre has information about a variety of mental health conditions in parent-friendly language. http://www.knowledge.offordcentre.com/
  • Children's Mental Health Ontario is the professional association representing children's treatment centres throughout Ontario, however they also have an excellent section of reviewed links to useful websites with child and youth mental health information.
    http://www.cmho.org
  • Dealing with Depression is an excellent, free, downloadable guide developed by the University of British Columbia specifically for young people
    http://www.mheccu.ubc.ca/documents/publications/DWD_PrintVersion.pdf 

Books for teens

  • My Kind of Sad : What It's Like to Be Young and Depressed by Kate Scoran, 2006

Books for parents

  • Helping Your Teenager Beat Depression: a Problem-Solving Approach for Families by Katharina Manassis and Anne Marie Levac, 2004 

References

  • Practice parameter for the assessment and treatment of children and adolescents with depressive disorders, American Academy of Child and Adolescent Psychiatry, 2007. Retrieved Oct 10, 2007 from http://www.aacap.org/galleries/ PracticeParameters/InPress_2007_DepressiveDisorders.pdf .
  • Bridge et al.: Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment. Journal of the American Medical Association, 2007; 297:1683.1696. Retrieved Oct 10, 2007 from http://jama.ama-assn.org/cgi/content/abstract/297/15/1683.

About this Document

Written by the eMentalHealth Team and Partners.

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance. 

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Date Posted: Oct 29, 2008
Date of Last Revision: Sep 1, 2014

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