Health Library

Major Depression

Depression involves the body, mood and thoughts. It can affect eating, sleeping or thinking patterns. It is not the same as being unhappy or in a “blue” mood. It is not a sign of weakness or something that can be willed or wished away.

Children with a depressive illness cannot just “pull themselves together” and get better. Treatment is often needed. Many times, treatment is crucial to recovery.

Incidence of Depression

The National Institute of Mental Health (part of the NIH) reports that:

• Research shows depression is starting earlier in life now than it did in the past.
• Early-onset depression often persists, recurs and lasts into adult age. Depression in youth may also predict more severe illness in adult age.
• There is an increased rate of depression in children whose parents have depression.

Risk Factors for Major Depression

The exact cause is not known. The most common risk factors include:

• Family history of mental illness, including depression and suicide (even more so if a parent had depression as a child or teen)
• A high amount of stress
• Abuse (physical, sexual or emotional) or neglect
• Trauma (physical, emotional or sexual)
• Other psychiatric disorders
• Loss of a parent, caregiver or other loved one to divorce, death or abandonment (even more so if at an early age)
• An imbalance of neurotransmitters (natural chemicals) in the brain
• Change in the body’s balance of hormones
• Loss of a relationship (like moving away, loss of boyfriend or girlfriend)
• Other chronic illness (like diabetes)
• Other developmental, learning or conduct disorders
• Low self-esteem, depends too much on others, self-critical or pessimistic

After puberty, girls are two times as likely as boys to be at risk for major depression.

What are the Signs and Symptoms of Major Depression?

These are the most common symptoms of major depression. This may be different for each child or teen. Symptoms may include:

• Lasting feelings of sadness, irritability, hostility or aggression
• Feeling hopeless or helpless, worthless or inadequate, or having low self-esteem
• Feeling empty inside
• Having a lot of guilt
• Thoughts of suicide or death that reoccur
• Loss of interest in normal activities and no longer enjoying pleasurable activities
• Problems with relationships
• Sleep problems (insomnia, hypersomnia)
• Changes in appetite or weight
• Change in activity level (increased or decreased energy)
• Problems concentrating, remembering or thinking clearly
• Less able to make decisions
• Frequent physical complaints (headache, stomach ache, very tired)
• Running away or threats of running away from home
• Very sensitive to failure or rejection
• Anger and rage
• Anxiety

Depression in children and teens may be hard to spot. Any of these signs may suggest problems with school, behavior or alcohol and drug use.

For a diagnosis of major depression, a child or teen often needs to have a “cluster” (often five or more) of the above symptoms during the same two-week time frame. The symptoms may look like other problems or conditions. Symptoms must be severe enough to cause problems in daily activities. Always talk to your child’s doctor for a diagnosis.

How is Major Depression Diagnosed?

Depression often co-exists with other psychiatric disorders (such as bipolar disorder, substance abuse or anxiety disorders). Seeking early evaluation, diagnosis and treatment is crucial to recovery.

A psychiatrist or other mental health expert most often diagnoses major depression after a full evaluation. An evaluation of the patient’s family, in addition to information provided by teachers and care providers, may also be helpful in making a diagnosis.

How is Major Depression Treated?

Treatment for major depression will be advised by your child’s doctor based on:

• Your child’s age, overall health and history
• Extent of symptoms
• Your child’s tolerance for certain medicines, procedures or therapies
• What is expected for the course of the condition
• Your opinion or what you prefer

Mood disorders, like major depression, can be effectively treated. Treatment should always be based on a full evaluation of the child and family. Treatment may include one, or more, of these:

• Antidepressant medicines. Research shows that, when combined with psychotherapy, these drugs can be very effective in the treatment of depression in children and teens. These medicines work by rebalancing the chemicals in the brain. Anyone taking antidepressants should be watched closely for suicidal ideation during the first few months after starting these.
• Psychotherapy. Most often, cognitive behavioral and / or interpersonal therapy is helpful. The focus is on:
• Changing distorted views of themselves and the environment around them
• Working through difficult relationships
• Identifying stressors in their environment and learning how to avoid them
• Family therapy.
• Consults with the school.

Parents play a vital role in any treatment process. For many reasons, many parents of children with depression never seek the needed treatment for their child. But, around 80% of all people with major depression who do seek treatment will improve, most often within weeks. Continued treatment may help to prevent the depressive symptoms from coming back.

Without the right treatment, symptoms of depression can last for weeks, months or years. This can cause interpersonal and psychosocial problems. Depression in teens is also linked with an increased risk for suicide.

Depression often gets worse if left untreated.

Suicide risk rises, even more so in teen boys, when the depression occurs with other mental health disorders (conduct disorder, substance abuse). It is crucial for parents and care providers of teens to take all depressive and suicidal symptoms very seriously. Seek treatment right away for any symptoms.

Suicide is a medical emergency. Consult your child’s doctor for more information.

Contact Us

You can reach the Psychiatric Intake Response Center (PIRC) at Cincinnati Children’s at 513-636-4124.