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Depression

Introduction

Here you’ll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in the Depression module, which is written for primary care clinicians but also may be of help to parents and family members.

What is depression and what causes it?

Everyone occasionally feels blue or sad. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression illnesses are disorders of the brain, and are common but serious. Most likely, depression is caused by a combination of genetic, biological, environmental, and psychological factors. Longstanding theories about depression suggest that important neurotransmitters are out of balance.

What are the symptoms of depression?

People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness. Depression is most commonly episodic. Episodes can last from months to years. The majority of episodes will last from 6 months to one year.
Signs and symptoms include:
  • Persistent sad, anxious, or "empty" feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

How is it diagnosed?

The first step is to visit a medical doctor or mental health specialist. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A clinician can rule out these possibilities by doing a physical exam, interview, and lab tests. If the clinician can find no medical condition, the next step is a psychological evaluation. A mental health professional should discuss any family history of depression or other mental disorder, and get a complete history of the symptoms. The mental health professional may also ask about alcohol or drug use, and thoughts of death or suicide. Once diagnosed, a person with depression can be treated in several ways.

What is the prognosis?

Depression is most often recurrent. Up to 70% of adolescents with major depression will experience some degree of recurrence within 5 years.

What is the risk for other family members or future babies?

Depression does appear to have a genetic component. Risk of depression in first degree relatives of a person with depression is about 2 times as high as someone in the general population.

What treatments/therapies/medications are recommended or available?

Depression, even the most severe cases, can be effectively treated. The earlier that treatment can begin, the more effective it is. The majority of depressive episodes will last from 6 months to one year, so the general recommendation for medications is that they be continued for at least one year from symptom improvement. Therapy should probably continue at least that long.
In some cases of mild to moderate depression, psychotherapy alone may be a reasonable treatment option. This decision should be made in collaboration with your primary care clinician. Be aware that the positive effects of psychotherapy may take longer to realize than those of medication.

How will my child and our family be impacted?

The impact of depression on a child or adolescent with depression and her family will depend on the severity of the depression and the resources that are available to treat the child. In addition to good health care, positive support from family, friends, school, and the community are critical to optimizing health and functional outcomes.

How do children and teens experience depression?

A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop depression. By age 15, however, girls are twice as likely as boys to have had a major depressive episode. Depression in adolescence frequently co-occurs with other disorders such as anxiety, eating disorders, or substance abuse. It can also lead to increased risk for suicide.

Are antidepressants safe in children and adolescents? I heard that they could cause suicidal thinking.

In about 4% of children and adolescents participating in studies of antidepressants, some degree of worsening of suicidal thinking occurred. It is important to note that suicidal thoughts are also a symptom of depression, and these studies were not designed primarily to assess for this side effect. Even more important to note is that in over 4000 subjects, 0 committed suicide in these studies.

What illnesses often co-exist with depression?

Other illnesses may come on before depression, cause it, or be a consequence of it. But depression and other illnesses interact differently in different people. In any case, co-occurring illnesses need to be diagnosed and treated.
Anxiety disorders, such as post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, social phobia, and generalized anxiety disorder, often accompany depression. Alcohol and other substance abuse or dependence may also co-exist with depression. Treating the depression can also help improve the outcome of treating the co-occurring illness.

Resources

Information & Support

Where can I go for further information?
If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.
Mental Health Resources:
  • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
  • Health maintenance organizations
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • Mental health programs at universities or medical schools
  • State hospital outpatient clinics
  • Family services, social agencies, or clergy
  • Peer support groups
  • Private clinics and facilities
  • Employee assistance programs
  • Local medical and/or psychiatric societies

For Parents and Patients

Support

National Institute of Mental Health
The Child and Adolescent Mental Health menu for National Institute of Mental Health.

National Alliance on Mental Illness
Provides information about mental illnesses, links to state chapters, information about conferences, and links to additional resources.

NAMI Utah
Utah Chapter of the National Alliance on Mental Illness; provides advocacy and information about mental illnesses.

General

Mental Health America
National non-profit organization, with numerous local affiliates, dedicated to helping all people live mentally healthier lives. Includes information on a variety of mental health topics in English and Spanish.

Understanding Depression (Kidshealth)
Depression is the most common mental health problem in the United States. Each year it affects 17 million people of all age groups, races, and economic backgrounds. As many as 1 in every 33 children may have depression; in teens, that number may be as high as 1 in 8.

The Depressed Child (AACAP)
Children and teenagers as well as adults may have depression, as well. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function and is treatable.

Children's Mental Health (Mental Health America)
A primary goal of Mental Health America is to educate the general public about the realities of mental health and mental illness.

Depression and Other Disorders (SAMHSA)
Information about depression, anxiety disorders, and others.

Depression (NAMI)
Clinical depression is a brain disorder (mental illness) that affects the whole person-it affects the way one feels, thinks, and acts. Early-onset depression can lead to school failure, alcohol or other drug use, and even suicide. However, it is highly treatable.

Child Mental Health (Medline Plus)
Mental health problems can disrupt daily life at home, at school or in the community. Talk to your health care provider if you have concerns about your child's behavior.

Teen Mental Health (Medline Plus)
Being a teenager is hard. You're under stress to be liked, do well in school, get along with your family, and make big decisions. Feeling very sad, hopeless or worthless could be warning signs of a mental health problem. You might need help if you have the signs mentioned above.

Allies with Families
Provides information and support to families of children with mental health needs. Wellness education and training: emotional support, training, and resource information for families of children with emotional, behavioral, and mental health disabilities, including workshops for siblings.

Teens & Young Adults (NAMI)
What families need to know about adolescent depression, by NAMI, National Alliance on Mental Illness

Services

Clinical Social Worker (LCSW, MSW)

See all Clinical Social Worker (LCSW, MSW) services providers (224) in our database.

Mental Health Counselors (LPC, CMHC)

See all Mental Health Counselors (LPC, CMHC) services providers (308) in our database.

Psychiatrist, Child-18

See all Psychiatrist, Child-18 services providers (28) in our database.

Psychologist, Child-18

See all Psychologist, Child-18 services providers (151) in our database.

Social Work

See all Social Work services providers (3) in our database.

For other services related to this condition, browse our Services categories or search our database.

Authors

Contributing Author: URLEND Trainees, 2011-2012 - 3/2012
Reviewing Author: Thomas G. Conover, MD - 3/2012
Content Last Updated: 11/2015

Funding/Support

The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.