Depression

Feeling sad or fed up is a normal reaction to experiences that are difficult or stressful. Sometimes these feelings of sadness can go on for some time and can start to interfere with everyday life. At these times the low moods become part of an illness we call ‘depression’.

Depression is thought to occur in around 1-3 % of children and young people. Anybody can suffer from depression and it happens in people of all ages, races, income levels and educational levels. Teenage girls are twice as likely as teenage boys to be depressed.

There will sometimes be a clear reason for becoming 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. We describe a few of the common reasons below.

Life events and personal circumstances

Depression can be triggered by a stressful or distressing event, such as a bereavement or even changing school or moving to a different place.

Physical health

Sleep, diet and exercise can all affect our mood and how we cope with things.

Physical health problems, particularly those that are serious or long-term, can cause depression or make it worse. These include:

• life-threatening illnesses like cancer and heart disease
• long-term and/or painful illnesses, like arthritis
• viral infections like 'flu' or glandular fever – particularly in younger people
• hormonal problems, like an under-active thyroid
• conditions affecting the brain or nervous system.

Childhood trauma

Some people may be more vulnerable to depression than others. This may be because of difficult childhood experiences or trauma, which can include abuse (physical, sexual or psychological), neglect, witnessing violence or a traumatic event, or an unstable family environment.

Alcohol and drug use

Regular heavy drinking or using drugs like cannabis can make someone more likely to become depressed in the long-term.

For more information see our information on alcohol, mental health and the brain.

Genetic factors

Similar genetic ‘risk factors’ are involved in whether someone develops severe depression, bipolar disorder or schizophrenia. There are also environmental risk factors, and these can interact with genetic risk factors to increase or decrease someone's risk of developing these conditions.

For example, someone might have genetic risk factors that mean they are more likely to develop severe depression. However, if they grow up or live in a stable and positive environment this may reduce their risk of developing a serious mental illness.

Having a parent with a serious mental illness like severe depression is the strongest known risk factor for someone developing a serious mental illness . Children with a parent who has a serious mental illness have a 1 in 3 chance of developing a serious mental illness themselves.

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.

When a child or young person is depressed many changes can be seen. The child or young person may:

• lose interest in activities that child/young person enjoyed before
• lose their appetite or start over-eating
• have problems of concentration, in remembering things or in making decisions
• have thoughts of suicide or self harm
• have disturbed sleep or sleep far too much
• feel tired all the time, exhausted
• complain of aches and pains like headaches, tummy pains
• have little self-confidence
• express feelings of guilt for no reason.

In children, especially teenagers, being irritable and grumpy all the time can also be a symptom of depression, not just being in a ‘bad mood’.

At the extreme end of depression, some young people can develop ‘psychotic symptoms’. They may start to have very unusual and sometimes unpleasant thoughts and experiences.

Some children also have periods of high mood, also called ‘mania’ along with having periods of low mood. They may suffer from bipolar mood disorder.

A child or young person with depression can have major problems in not only how they feel, but also on how they behave. This may cause difficulties at home, at school, as well as relationships with family and friends. Some young people can struggle with other problems which can be risky. These can include self-harming like cutting, misusing drugs and alcohol, having inappropriate sexual relationships (leading to teen pregnancy in girls), dropping out of school and suicide.

The longer the illness continues without understanding, help or treatment, the more harmful it is likely to be to the life of the young person and to their family.

Depression is a treatable illness. The first step towards getting help is to recognise that there might be a problem. It might help to talk to others who know your child. Contact the school for instance to find how they are doing.

If you suspect that young person is depressed, seeking medical advice early on is very important. You should contact your GP. If necessary, they can then make a referral to your local child and adolescent mental health service (CAMHS) which can offer more specialist help.

The goal of treatment is to improve the symptoms, prevent the illness from returning and help the young person lead a normal life. Families play an important role in recognising the illness, supporting young person through treatment and also preventing the illness from coming back. It is therefore very important that you understand the condition.

Depending on how depression is affecting your child, how severe it is, they may need different treatments. When they have severe symptoms or have difficulties like having serious suicidal thoughts or other risky behaviours, they may need medications and also sometimes admission to hospital.

Psychological or talking treatments and medication, both may have an important role in treatment of this condition.

Talking treatments (also known as ‘psychotherapies’)

Psychological therapies like CBT (Cognitive Behavioural Therapy) or ‘interpersonal therapy’ may be tried before considering other possibilities such as medication. However, this can depend upon the individual’s illness or their personal circumstances.

Medication

Certain antidepressant medications, known as selective serotonin reuptake inhibitors (SSRIs), have been shown to be beneficial to children and adolescents with severe depression.

Medication once started should not be stopped suddenly. Medication may be needed for months or even years. Some people may, under medical supervision, be able to stop their medication when they have recovered and have felt well for a while.

They may need physical examinations and tests (like blood tests) before starting the treatment, or while on medication. It is important that if the young person is prescribed medication that they are seen regularly by their doctor or psychiatrist.

There are side-effects to medication, some of which can be quite serious. The psychiatrist will be able to advise you about what they are and about what can be done to help. The risk of side-effects needs to be balanced against the risk of the damaging effects of the illness on a person's life.

No young person should be taking medication unless they are reviewed regularly by a health professional. This is to monitor the dose of the drug and to check for side-effects.

Recognising and understanding your child’s illness is a huge step in knowing how you can help. When your child becomes irritable or even does something risky, it is common you feel angry or upset. It is important that you try to remain calm and be honest about letting them know what you feel and seek help.

Some children may be reluctant to talk to you about it, although they might do talk to someone at school, friends or their GP or a professional for young people at health centre or CAMHS. It is important to encourage them to talk to someone they can trust, as well as seeking professional help.

Having little chats, spending time with them like watching TV, cooking and even physical activities like walking can help to lift their mood even if they say they do not want to do it. A healthy diet and physical exercise can help improve their mood. (add link or see leaflet on exercise and mental health)

Millie was 15 when she started staying up late at night, not sleeping, eating a lot and spending most of the time in her room. We thought this was because the demands from school had increased. We didn’t even really notice that she wasn’t meeting up her friends or talking to us like usual. We took her to see the doctor because we thought she was a bit down and pale. The doctor was concerned and asked her questions which opened our eyes.

I soon noticed Millie had started cutting herself. When I confronted her about this she became upset. She accused us of ‘having a go’. Millie said she just couldn't be bothered anymore with anything .The more we talked, the more Millie started to acknowledge that she needed help. Millie told us she just couldn't enjoy things anymore like she used to. She said she couldn't focus on her schoolwork and was falling behind. Teachers were noticing this saying she wasn't getting on with her work.

We took Millie back to her doctor and then to see a therapist at CAMHS. It wasn’t until Millie started to talk about how she was feeling that things started to change. We are just so pleased the help was there when Millie needed it. Millie has moved further on now and will soon be starting college. She is now back to her usual

National Institute of Mental Health

National Institute for Health and Clinical Excellence: (2005) Depression in children and young people: Clinical Guidelines CG28.

Young Minds - Provides information and advice on child mental health issue and a Parents'Helpline:0800 802 55

References

Mufson, L. & Sills, R. (2006). Interpersonal Psychotherapy for depressed adolescents (IPT-A): An overview. Nordic Journal of Psychiatry. Vol. 60, No. 6. Pages 431-437

Depression in Children and Young People (2005). National Institute for Clinical Excellence.

Rutter’s Child and Adolescent Psychiatry, Fifth Edition (2008). Publisher: Wiley-Blackwell.

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Chris Abbott, Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy.

This resource reflects the best possible evidence at the time of writing.