By Dr. Catherine Larson

Depression is a medical illness with both genetic and environmental causes. In the United States about 2% of children and 4-8% of teens have Major Depressive Disorder at any given time. By the time youth reach age 18, about 20% will have had a Major Depressive Episode. Another 5-10% of children and teens have some symptoms of depression but do not meet the full criteria for diagnosis.

Untreated depression can lead to many problems in the child’s life: school, family and peer relationships. When severe, depression puts children and teens at risk for suicide. Suicide is the second leading cause of death in persons age 10-34 according to the Centers for Disease Control. The good news is that there are several forms of treatment which have been shown to be effective.

Early treatment of depression can improve long-term outcomes. As parents, we know our children best, so we are the first line for recognizing depression and getting our children the help they need. Children and teens often show different signs of depression than adults. Here are some of the possible signs of depression in children and teens.

  • No longer enjoying activities
  • Hopelessness
  • Low energy
  • Poor self-esteem
  • Isolation from friends or family
  • Irritability or anger
  • Mood swings
  • Frequent vague physical complaints
  • Changes in sleep
  • Changes in appetite
  • Discipline problems at home or school
  • Thoughts of suicide

What to do if you think your child may be depressed:

If you read this list and you recognize some symptoms that your child is exhibiting, it can be hard to know what to do next. Start by talking to your child with a loving, accepting and non-judgmental tone.

If you or your child feel that some of these symptoms are present and have persisted over an extended period of time, or if they are severe enough to interfere in their school functioning, their relationships (with parents, siblings, teachers or peers) or their activities, then it may be time to seek treatment.

If you feel your child may be struggling with depression, you may want to ask them about suicidal thoughts. Many parents fear that they will “cause” their child to have suicidal thoughts if they ask about them.

In reality, these questions may be what save your child. If your child is having suicidal thoughts, then it is better for you to know about them. If they are not having suicidal thoughts, you will not induce them by asking about them. Instead you will be showing your child that no matter how bad things get, there is nothing that is off limits for them to talk with you about.

It can be a difficult conversation. The way I often word this is, “It sounds like sometimes you feel pretty bad. Does it ever get so bad that you just wish you weren’t alive?” The answer to this question will help you to understand the severity of the depression. Suicidal thoughts occur in more severe depression and are cause for immediate evaluation.

Always err on the side of safety. Suicidal thoughts are considered a medical emergency. If your child is talking about suicide, has tried to hurt themselves or if at any time you feel they are unsafe, take them to an emergency room for evaluation and treatment. If you need immediate assistance, please dial 911. Another resource is the national suicide prevention line at 1-800-273-TALK (8255) which is available 24 hours per day, 7 days per week. There is also a crisis text line at 741741.

How to find help for your child:

If you notice some of the above symptoms, but do not feel they are in immediate danger from suicidal thoughts, then seeking outpatient treatment would be the first step. The best place to start is getting a comprehensive evaluation by a Board-Certified Psychiatrist (MD or DO).

Finding mental health care, especially when we are worried about our children’s welfare, can feel overwhelming. A good first step is contacting your pediatrician and asking for referrals. Another option is the website is psychologytoday.com which has a, “therapist finder” page. You can filter by your zip code and insurance. Search the list for an MD/DO near you.  The psychiatrist will evaluate your child and will recommend an individualized treatment plan that will include therapy, lifestyle changes and possibly medication.

Just by reading this article, you are supporting your child. Keeping the lines of communication open and being there for your child are the first steps toward helping your child to live a long, happy and healthy life.

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Catherine Larson, MD is a Board-Certified Child, Adolescent and Young Adult Psychiatrist. She is an Adjunct Professor at University of Texas School of Medicine at San Antonio and has a private Practice, Austin Child Psychiatry. Her blog at AustinChildPsychiatry.com/blog covers mental health and related topics. She can be followed on Instagram at @CatherineLarsonMD

References:

Dulcan, Mina K. (2016) Dulcan’s Textbook of Child and Adolescent Psychiatry. Second Edition. Arlington VA: American Psychiatric Association Publishing.

American Academy of Child and Adolescent Psychiatry (2018, March) Depression in Children and Teens.  

American Academy of Child and Adolescent Psychiatry (2017, October) Suicide in Children and Teens.

Centers for Disease Control and Prevention (2017, February) Leading Causes of Death Reports.

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