Depression

Feeling sad is a normal reaction to experiences that are stressful or upsetting. However, when these feelings go on for a long time, interfere with your life or make you feel unlike your usual self, you might have depression.

Some of the symptoms of depression can include:

• being moody and irritable - easily upset, angry or tearful
• having less energy than usual
• not enjoying activities that you previously enjoyed
• becoming withdrawn - avoiding friends, family, school and regular activities
• feeling guilty or bad, being self-critical and blaming or hating yourself
• feeling hopeless and wanting to die
• finding it difficult to concentrate
• not looking after your personal appearance or your personal self-care
• changes in sleep pattern - sleeping too little or too much, and feeling tired
• losing interest in eating, not feeling hungry, eating too little or too much
• unexplained aches and pains, such as headaches or stomach aches
• taking risks or harming yourself
  

If you have experienced more than one of these signs and have had them persistently for more than two weeks, it might mean that you are depressed.

As a young person with depression you may experience problems not only with how you feel, but also with how you behave. This can cause difficulties at home and at school, as well as in relationships with your family and friends.

Some young people start taking risks. These can include missing school, harming themselves through misusing drugs or alcohol, or having inappropriate sexual relationships. Sometimes young people with depression may self-harm, or try to kill themselves. If you are considering harming yourself, you should speak to someone you trust straight away.

A small number of young people with depression may develop ‘psychotic’ symptoms like hearing voices or believing that someone is trying to harm them. Some young people have periods of having a very low mood, followed by periods of having a very high mood. This might be a sign that you have bipolar disorder.

Find out more about psychosis and bipolar disorder.

Depression occurs in about 2.1% of 5-19 year olds. Anybody can experience depression and it affects people of all ages, ethnicities and social backgrounds. It is more common in older adolescents, particularly teenage girls.

Depression is not a sign of weakness, and it can happen to the most determined of people. Even extremely famous and successful people experience depression.

There will sometimes be a clear reason that someone becomes depressed, sometimes not. It can be a disappointment, a frustration, or because you have lost something or someone important to you.

There is often more than one reason, and these will be different for different people. Some common reasons include:

• Life events like someone dying, moving schools or other big changes
• Physical health problems
• Experiencing physical, sexual or psychological abuse or neglect, witnessing violence or a traumatic event, or if you have an unstable family environment
• Alcohol and drug use
• Genetic risk factors might make you more likely to develop severe depression. Having a parent with a serious mental illness can also make this more likely

When thinking about the causes of developing depression, it is important to remember that lots of different things are involved, and that no one risk factor causes depression.

Speak to your GP if you think you are experiencing depression. You might also be able to speak to your school nurse. They will be able to tell you what help is available and arrange a referral to the local Child and Adolescent Mental Health Service (CAMHS). They will see you and your family and discuss what the right treatment is for you. If you would like to see a professional without your parents, you can ask to have all or part of the appointment on your own.

Many young people will get better on their own with support and understanding from those around them. Some young people might find online ‘self-help’ resources useful. You can read more about these at the end of this resource.

However, you might need professional support if you are not getting better, feel as though you are getting worse, or if depression is causing significant difficulties for you.

If you have feelings that you want to hurt yourself, or if you are doing dangerous things to cope, like using alcohol or drugs, speak to someone you trust. It is important that you let someone know how you are feeling and get help quickly. 

There are a number of different treatments that can be helpful for people with depression. Some treatments might be more suitable for you than others, depending on your age, family circumstances, and how severe your depression is.

Psychological therapies

There are different kinds of psychological therapies, or ‘talking therapies’ that can be used to help someone with depression. Some people will have one-on-one therapy where they will work with a professional on their own. Some people may do this type of therapy online.

You might have heard of cognitive behavioural therapy (CBT), which helps you to manage your problems by changing the way you think and behave.

There are other therapies that might be helpful, including Interpersonal Therapy (IPT), group therapy and family therapy.

Everyone is different and it is important to work with professionals to find the right therapy for you. Your therapist should explain what kind of therapy you are having, and how it works.

Antidepressants

When your depression is severe or has been going on for a long time, you might be prescribed medication called antidepressants to help improve your mood. This can make it easier for you to take part in a psychological therapy.

Antidepressants need to be prescribed by a specialist doctor, called a Child and Adolescent Psychiatrist, after a careful assessment. In this assessment you will be asked questions to make sure that antidepressants are right for you. You will also get to ask any questions you might have. Before being given antidepressants, you may need a physical health check-up. 

Once you have started taking antidepressants, you will need regular check-ups with a psychiatrist and other mental health professionals. This is to check that they are working for you and not causing you any problems. You should let your psychiatrist know if you are having any side-effects, and they will tell you what side-effects to look out for.

If you find that the antidepressants help you to feel better, you would normally take them for at least six months after they start to work. However, you might need to take them for longer if you have had depression before, or if you still have a lot of stresses in your life. This is to reduce the risk of you developing depression again.

If you are prescribed antidepressants, it is important that you take them the way you have been told to (i.e. the same amount every day). When you stop taking antidepressants, this is usually done gradually over a few weeks or months. If you want to stop taking your antidepressants, speak to your doctor before doing so.

You can try a few things to see if they help you feel better:

• talk to someone you trust about how you’re feeling
• work with the people in your life to find practical solutions to problems. For example, if you feel unable to do your homework, letting your family and teachers know can help them to support you.
• try to do some physical activity and eat healthy food
• try to keep yourself occupied by doing activities, even if you feel you do not really feel like doing anything. This can get easier the more you practice
• try not to spend lots of time alone, and reach out to friends and family
• don’t put too much stress on yourself and allow time for fun and leisure
  

It might help to find out more about depression and mental health. There is more information about this further on in this resource that you might find helpful.

Some people find online support groups helpful, as they allow them to connect with other people having similar experiences and learn more about depression and mental health problems. However, you shouldn’t feel like you have to connect with other people or read about what you are going through online. If you see or hear things that are upsetting or distressing, talk to someone that you trust.

Remember you are not alone - depression is a common problem and can be overcome.

“I was 15. They took me to see the doctor because they thought I was a bit down and I had started cutting. I hadn’t noticed much, cutting made me feel better and I just felt they were having a bit of a go really. It was only when I started to talk more, that I started to realise how much I had changed, I used to be happy, not all the time, but I couldn’t feel happy at all now - not like I used to.

“I was falling out with my teachers - they said I wasn’t getting on with work and it made me cross. I was trying but I just couldn’t get on with it - not like I did in year 8 and 9. The doctor said it could be my concentration. I hadn’t thought of that, I just thought I was thick.

“Then when he asked about other things, I started to see, I couldn’t sleep properly and didn’t feel like going out to play football anymore. I said it was just boring, but as I started to feel better, I did play again and I think saying it was boring was all part of my depression.

“That was the same with my family, I mean we don’t get on all the time and they are still a pain sometimes now, but when I was depressed it was like we were always arguing, I just couldn’t talk to them and they just wound me up.

“It wasn’t until they talked to me and things started to change, that was when I looked back and realised how depressed I was.”

• Childline – a free and confidential telephone service and online chat for children and young people. Helpline: 0800 1111
• Epic friends - self-help resources and advice for helping friends.
• YoungMinds - information and advice on child mental health issues, including information about medication.
• Rethink Mental Illness - factsheets and information for young people and their families as well as a helpline for advice and local peer support groups.
• MindEd – Helpful resources for parents, carers, young people and professionals.
• Campaign Against Living Miserably (CALM) – a free and confidential helpline and webchat, 7 hours a day, 7 days a week for anyone who needs to talk about life’s problems.
• Kooth – online support and resources including free online counselling.
• Charlie Waller Memorial Trust - free resources for professionals, parents and young people.
• Students against depression (Charlie Waller Memorial Trust) – Clinically based self-help information and activities.

This information was produced by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB). It reflects the best available evidence at the time of writing.

Expert authors: Dr Mathew Fernando, Dr Virginia Davies, Dr Vasu Balaguru, Dr Amy McCulloch and Dr Bernadka Dubicka

With grateful thanks to the National Collaborating Centre for Mental Health (NCCMH).

Full references available on request.