Depression in children

What is depression?

Depression is an overwhelming feeling of hopelessness, sadness and lack of self-worth. Many people feel sad occasionally, but when someone is depressed, the sadness or feeling low are so extreme or persistent that they get in the way of normal activities.

Causes of depression

The causes of depression aren't fully understood. Many factors can contribute, such as losing a loved one (or in children, a good friendship breaking up), illness, stress, family problems (for example, parents who are splitting up) and problems (such as bullying) at school. Some children are more resilient to difficulties than others, so while some cope, others become depressed.

Genetics and family tendencies may partly explain why some people are more susceptible to depression. It may also explain why the levels of certain brain chemicals become abnormal in depression.

Who's at risk of depression?

In the early 1980s, many psychiatrists believed children were incapable of experiencing depression because they lacked the emotional maturity to feel despondent. However, most children feel down at times.

At least two per cent of children under 12 struggle with significant depression, and by teenage years this has risen to five per cent - that's at least one depressed child in every classroom.

More than half of the adults who develop depression say they can pinpoint early symptoms before the age of 20.

Symptoms of depression in children

There are many symptoms related to depression, which can make it difficult to spot. Common depression symptoms in children include:

• Simply appearing unhappy much of the time.
• Headaches, stomach aches, tiredness and other vague physical complaints that appear to have no obvious cause.
• Spending a lot of time in bed but sleeping badly and waking early in the morning.
• Doing badly at school.
• Major changes in weight.
• Being unusually irritable, sulky or becoming quiet and introverted.
• Losing interest in favourite hobbies.
• Having poor self-esteem or recurrent feelings of worthlessness.
• Contemplating suicide.

It isn't always easy to spot depression in children because they're less capable of expressing their feelings and often tend to react to their moods in a more physical way. So, while some children are clearly sad, withdrawn and tearful, others may become hyperactive, troublesome bullies.

If you're worried about your child, especially if they've had symptoms for longer than three to four weeks, you should talk to your GP. Also talk to your children's friends, to try to get a different perspective on their feelings.

If your child ever talks about suicide, you should always take them seriously and get expert advice. Children's threats are often dismissed as being empty or no more than attention-seeking. It's important to involve other family members and improve communication and support within the family.

Depression is poorly understood, but some children are more at risk, particularly those who have a physical illness, have been abused, or come from a home where there is marital disharmony or family breakdown.

However, many simpler worries can also trigger an episode of depression, such as exam fears.

The mental health charity Rethink has advice tailored to some of these common causes of unhappiness.

Diagnosing depression

If you are worried that your child might be depressed, talk to your doctor. Diagnosis is usually based on the medical history and symptoms, so your doctor will need to talk to the child.

Treating depression in children

Treatment consists of talking therapies, such as counselling or psychotherapy, and antidepressants. Simply talking about the problems to family and friends is often a major step towards recovery.

Although children might not find this easy at first, it's essential to help them understand why they became depressed, how they can deal with the underlying problems in their life and how they can develop a more positive view of their world. This usually involves some sort of psychotherapy.

Like adults, children with depression can't just 'snap out of it' or 'pull themselves together'. It's a long-term problem with episodes of depression lasting, on average, eight months.

While the majority of depressed children are back to normal after a year or two, at least half are likely to become depressed again within a couple of years.

Children usually respond fairly quickly to treatment. Antidepressants are rarely needed but may be useful in some cases. Most children can be treated at home or as a hospital outpatient, so rarely need to stay in hospital.

If you're worried that your child might be suicidal, talk to your doctor immediately - and try talking to your child too.

Support and advice

• Royal College of Psychiatrists
• Mental health information leaflets
• Website: www.rcpsych.ac.uk/mentalhealthinformation

• Young Minds
• Parents' information service: 0800 018 2138
• Website: www.youngminds.org.uk