Depression

Everyone feels sad or ‘low’ from time to time. This is a normal part of growing up. Many young people have times where life feels especially difficult, or where they feel hopeless. This can be because something difficult or upsetting has happened. For example, if someone in your family has died, or if you have experienced a big life change like moving school, college or house. Or you might just feel misunderstood by friends or family, or lonely for no particular reason.

If you are feeling low, anxious or sad it’s important you speak to someone about it. Even if you don’t have a mental health condition like depression, your feelings can still be very distressing and you still deserve support and understanding from the people around you.

It’s important to take it seriously if you are feeling sad, because things can get worse without help.

Talk

The more we don’t talk about things, the bigger our problems can feel. Just telling someone how you’ve been feeling can feel like a big relief. You can talk as much or as little as you feel comfortable with, but even just having someone you trust by your side can help with some of your difficult feelings.

It can be difficult to speak to people about how you’re feeling. We know that young men in particular can find it hard to share how they’re feeling with their friends. However, often when we talk to people about how we’re feeling we find out that they have also had times when they have felt low.

Who you choose to speak to depends on you. It could be a family member, a friend or a teacher at school or college. If there is something happening in your life that is making you feel sad, they might be able to help you with these things. Or they might be able to point you to places you can get further help.

Try to connect with people in person rather than only over the phone or on social media. While it’s great to stay in touch virtually, seeing someone in person can help you to feel more connected.

Look after your physical health

It might sound obvious, but looking after your physical health can be really good for your mental health.

Find a form of physical exercise that you enjoy, and try to do it regularly. You should try to get at least an hour of moderate exercise a day, such as walking or cycling to school or college. And you should try to get one hour of vigorous exercise three times a week, such as running or swimming. Take a look at our physical activity resource to find out more.

Sleep can also have a big impact on your mental health, and children and young people usually need more sleep than adults. Everyone should have a regular sleep time routine. Try not to stay up very late, or to sleep in very late. A lie in can be a nice treat on the weekend, but if you sleep in late every day this can leave you feeling even more tired. It can also affect your daily routine and how you feel throughout the day, at school or in college.

Learn a new skill

This could be anything, as long as it is something that you enjoy, are interested in or have always wanted to try. Some examples include cooking a new meal, learning to knit or crochet, painting a picture or writing a short story. You could also join a club or class at school, college or in your local area.

Do things for others

Research shows that doing things for others can:

• help you to feel positively about yourself
• give you a sense of self-worth
• help you to connect with others.

This could be as simple as telling a friend something that you like about them. Or you could even volunteer in your local community.

Spend time outside

Being outside can also have a positive effect on your mental wellbeing. Spending time outside in green areas such as parks, woods or the garden can reduce stress and improve your mood. You could go for a walk or a cycle, try gardening, or even just sit outside. Exercising outside is even more beneficial than exercising indoors.

If you have spoken to family and friends and are still feeling sad or distressed, you might find it helpful to speak to a professional. Some schools and colleges have a mental health support team or counsellors. These are members of staff at your school or college who have been trained to support you with your mental health. If you don’t have these roles in your school or college, or you would prefer to speak to someone else, you could also speak to your GP.

The person you speak to might ask you about:

• your feelings and thoughts
• your general health
• any other conditions you might have
• your relationships with family and friends
• your home life
• your experiences of school or college

They should work with you to understand the good and bad things that are happening in your life and what might be causing you to feel sad.

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. Or if you would like someone with you, you could ask a trusted person to join you in the room or ask for a chaperone. A chaperone is someone who works at your GP practice who can join you in the appointment if you are worried about doing it alone. If a chaperone isn’t available at your GP, you could also look for an independent advocate.

Speaking to someone is an incredibly brave thing to do. You should be proud of yourself for taking this first step.

Depression is a mental health condition. People with depression feel sad, irritable or empty, and lose interest and enjoyment in the things around them. This will significantly affect their ability to function personally, socially, at home, in school or college, or at work.

Sometimes people use the word ‘depressed’ to describe feeling sad or down. This can make it confusing to know what the difference is between being sad and experiencing depression. There are similarities between the two, but depression is more serious than just feeling sad.

Here, we have listed some of the symptoms of depression.

• feeling sad and low constantly or most of the time
• 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 or college, and regular activities
• feeling guilty or bad, being self-critical and self-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
• recurrent thoughts of death or suicide

These symptoms might cause you problems at home, at school or college, or in your relationships with family and friends. You might even use alcohol or drugs to feel better. Unfortunately, this can make everything much worse.

It’s important to remember that most of us experience some of these things from time to time, and this doesn’t mean we are depressed. However, you might have depression if:

• you’ve experienced these things intensely and they have continued for a number of weeks or months
• and they are having a negative impact on different areas of your life.

It is also important to remember that not all of the symptoms listed above are normal for everyone to experience. For example, not everyone thinks about death or suicide.

If you are thinking about wanting to die, or are making plans to kill yourself, speak to someone straight away. You can also contact the Samaritans or Childline.

If you have hurt yourself, call 999 or go to A&E if you are able to, or ask someone to take you.

You might hear depression described in levels of severity. For example: mild, moderate or severe depression. These categories are used to help understand:

• how bad your feelings are
• how long they’ve been going on for
• what impact they’re having on your life.

Around 2 in every 100 children and young people will experience depression. Depression can happen to anyone, and it affects people of all ages, ethnicities and social backgrounds. In young people, depression is more common in older adolescents, particularly teenage girls. We know that the earlier we get help with depression the better.

Depression can happen to the most determined of people and is not a sign of weakness. Many very famous and successful people experience depression.

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

• Life events like someone dying, moving school or college or other big changes
• Physical health problems
• Experiencing physical, sexual or psychological abuse or neglect
• Witnessing a traumatic event
• Living in an unstable family environment
• Alcohol and drug use
• Genetic risk factors, such as having a parent or sibling with a mental illness

Sometimes there is no clear reason for why someone becomes depressed. When thinking about the causes of depression, it is important to remember that lots of different factors might cause an episode of depressive illness. No one risk factor causes depression. 

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. This will depend on your age and how severe your depression is.

If this is the first time you have felt depressed, your GP might suggest that you wait for a couple of weeks to see if you feel better on your own. This doesn’t mean that what you’re experiencing isn’t real or important, but is because depression can sometimes improve on its own over time. This is called ‘waiting and watching’.

Your GP should put in a meeting to check in with you to see how you are getting on. They might also offer you some online courses or information. Or they might recommend that you try some of the self-help methods mentioned at the beginning of this resource.

Psychological therapies

You might be offered psychological therapy. This is where you see a mental health professional about how you are feeling, one-on-one or in a group. Therapy can be done in-person or online.

Some young people don’t feel ready to speak to anyone about their feelings. If that is the case with you, there are types of therapy where you don’t have to speak about your difficult feelings or experiences (eg. art therapy, play therapy). You might find these more useful.

There are different kinds of psychological therapies, or ‘talking therapies’ that can be used to help you if you have depression.

You might have heard of cognitive behavioural therapy (CBT). This can help you to learn more helpful ways of thinking and reacting in everyday situations.

There are other therapies which may be considered such as:

• Interpersonal Therapy (IPT)
• group therapy
• or 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. Your therapy should be given to you by someone who is a specialist in children and young people’s mental health.

Child and Adolescent Mental Health Services

If your depression is having a really negative effect on your life or has been going on for a long time, you might be referred to a child and adolescent mental health service (CAMHS).

CAMHS is a specialist team made up of experts in mental health problems in children and young people. You will receive an assessment that will look at what you are struggling with and what kind of support you might need. As well as psychological therapies, you might also be offered antidepressant medications.

Antidepressants

You might be prescribed a medication called an antidepressant if:

• your depression is having a really negative effect on your life
• and other treatments like psychological therapies haven’t worked.

Antidepressants can help to improve your mood. This can make it easier for you to make the most of 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. 

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. Antidepressants can have side-effects, and your psychiatrist should tell you what to look out for. If you experience any of these side effects, you should speak to them straight away.

What kind of antidepressant would I be given?

The antidepressant usually prescribed to children and young people is called a selective serotonin reuptake inhibitor (SSRI).

How long would I need to take an antidepressant?

If you find that the antidepressant helps you to feel better, you would normally take it for at least six months after it starts to work. However, you might need to take it 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.

What if I want to stop taking my antidepressants?

If you are prescribed antidepressants, it is important that you take them the way you have been advised to (ie. the same amount every day).

If you want to stop taking your antidepressants, speak to your doctor first, as it is important that this happens in a controlled way. Usually, you will need to gradually reduce your antidepressants over a few weeks or months. If you are experiencing severe side-effects, you may need to stop more quickly. Speak to your doctor if you are experiencing unpleasant side-effects or want to stop taking your antidepressants.

You might find it helpful to find out more about depression and mental health. There are resources at the end of this resource that can tell you more.

Some people find online support groups helpful. Your GP might be able to suggest support groups that are local to you. These can help you connect with other people with similar experiences and learn more about depression and mental health problems.

You shouldn’t feel under pressure to connect with other people or read about what you are going through online. If you see or hear things in any online forum or contents that are upsetting or distressing, talk to someone that you trust.

Remember you are not alone - depression is a common problem and help is available.

“I was 15. They took me to see the doctor because they thought I was a bit down and I had started self-harming. I hadn’t noticed much, self-harming 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, childline.org.uk – a free and confidential telephone service and online chat for children and young people. Helpline: 0800 1111 

Epic friends, epicfriends.co.uk - self-help resources and advice for helping friends. 

YoungMinds, youngminds.org.uk - information and advice on child mental health issues, including information about medication

Rethink Mental Illness, rethink.org - factsheets and information for young people and their families as well as a helpline for advice and local peer support groups.

MindEd. minded.org.uk – Helpful resources for parents, carers, young people and professionals.

Campaign Against Living Miserably (CALM), thecalmzone.net – 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, kooth.com – online support and resources including free online counselling.

Charlie Waller Memorial Trust, schools and families resources - free resources for professionals, parents, young people

Students against depression (Charlie Waller Memorial Trust), studentsagainstdepression.org – 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.