What Is Depression?

Major depression is one of the mental, emotional, and behavior disorders that can appear during childhood and adolescence. This type of depression affects a young person’s thoughts, feelings, behavior, and body. Major depression in children and adolescents is serious; it is more than “the blues.” Depression can lead to school failure, alcohol or other drug use, and even suicide.

What Are the Signs of Depression?

Young people with depression may have a hard time coping with everyday activities and responsibilities, have difficulty getting along with others, and suffer from low self-esteem. Signs of depression in children and adolescents often include:

  • sadness that won’t go away;
  • hopelessness;
  • loss of interest in usual activities;
  • changes in eating or sleeping habits;
  • missed school or poor school performance;
  • aches and pains that don’t get better with treatment; and thoughts about death or suicide.
In this fact sheet, “Mental Health Problems” for children and adolescents refers to the range of all diagnosable emotional, behavioral, and mental disorders. They include depression, attention- deficit/hyperactivity disorder, and anxiety, conduct, and eating disorders. Mental health problems affect one in every five young people at any given time.”Serious Emotional Disturbances” for children and adolescents refers to the above disorders when they severely disrupt daily functioning in home, school, or community. Serious emotional disturbances affect 1 in every 10 young people at any given time.1

Some young children with this disorder may pretend to be sick, be overactive, cling to their parents and refuse to go to school, or worry that their parents may die. Older children and adolescents with depression may sulk, refuse to participate in family and social activities, get into trouble at school, use alcohol or other drugs, or stop paying attention to their appearance. They may also become negative, restless, grouchy, aggressive, or feel that no one understands them. Adolescents with major depression are likely to identify themselves as depressed before their parents suspect a problem. The same may be true for children.

How Common is Depression in Children and Adolescents?

Recent studies show that, at any given time, as many as 1 in every 33 children may have depression. The rate of depression among adolescents is closer to that of depression in adults, and may be as high as one in eight.2

Having a family history of depression, particularly a parent who had depression at an early age, also increases the chances that a child or adolescent may develop depression. Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next 5 years. This young person is also at risk for other mental health problems.

What Help Is Available for a Young Person with Depression?

While several types of antidepressant medications can be effective to treat adults with depression, these medications may not be as effective in treating children and adolescents. Additional research is needed to determine whether antidepressants are useful in helping young people. Researchers also are concerned about the potential severe side effects of these medications.

Some success has been reported recently with a drug called fluoxetine. Fluoxetine seems to have fewer side effects than other antidepressant medications. However, care must be used in prescribing and monitoring all medication.

Many mental health care providers use “talk” treatments to help children and adolescents with depression. The National Institute of Mental Health has made it a priority to evaluate the effectiveness of the following types of therapy:

  • individual psychotherapy;
  • family psychotherapy;
  • and group therapy.
In a “System of Care,” local organizations work in teams–with families as critical partners–to provide a full range of services to children and adolescents with serious emotional disturbances. The team strives to meet the unique needs of each young person and his or her family in or near their home. These services should also address and respect the culture and ethnicity of the people they serve. (For more information on systems of care, call 1.800.789.2647.)

A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions.

Tying together all the various supports and services in a plan of care for a particular child and family is commonly referred to as a “system of care.” A system of care is designed to improve the child’s ability to function in all areas of life–at home, at school, and in the community. For a fact sheet on systems of care, call 1.800.789.2647.

What Can Parents Do?

If parents or other important adults in a child’s or teenager’s life suspect a problem with depression, they should:

  • Make careful notes about the behaviors that concern them. Note how long the behaviors have been going on, how often they occur, and how severe they seem.
  • Make an appointment with a mental health professional or the child’s doctor for evaluation and diagnosis.
  • Get accurate information from libraries, hotlines, or other sources.
  • Ask questions about treatments and services.
  • Talk to other families in their community.
  • Find family network organizations.

It is important for people who are not satisfied with the mental health care they are receiving to discuss their concerns with the provider, to ask for information, and/or to seek help from other sources.

Important Messages About Children’s and Adolescents’ Mental Health:

  • Every child’s mental health is important.
  • Many children have mental health problems.
  • These problems are real and painful and can be severe.
  • Mental health problems can be recognized and treated.
  • Caring families and communities working together can help.
  • Information is available-publications, references, and referrals to local and national resources and organizations-call 1.800.789.2647; (TDD) 301.443.9006 or go to Mental Health America.

1: Prevalence of serious emotional disturbance in children and adolescents. Mental Health, United States, 1996. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 1996.

2: These estimates provide only a rough gauge of the prevalence rates (number of existing cases in a defined time period) for this disorder. The National Institute of Mental Health is currently engaged in a nationwide study to determine with greater accuracy the prevalence of psychological disorders among children and adolescents. This information is needed to increase understanding of mental health problems and to improve the treatments and services that help young people who are affected by these conditions.