Depression - Youth

Often kids get sad, or upset or grumpy, and that is normal. This is not what we meant when we talk about depression here.

Depression is an illness that can affect how children and adolescents feel and behave for weeks or months at a time. This will affect how they function in their day to day lives.

Depression can start at any age – from childhood through to old age. Very severe depression can result in symptoms of psychosis (loss of contact with reality). People with depression often have other problems such as anxiety disorders, substance use disorders and personality disorders, and may engage in deliberate self-harm and suicide attempts.

The risk of suicide in people with depression is significant. It is important that if you are having any suicidal thoughts you seek help immediately through a helpline or dial 111.

If you‘re concerned you may be depressed, a number of NZ websites have useful self-tests you can do, and there are sites just for children and young people. These are listed to the right.

Remember, depression is a serious illness and you do need to see your doctor if you suspect you, or a loved one, may be suffering from it.

Myths about depression

Depression is a sign of a weak character

NOT TRUE The fact is that depression can strike anyone. While some particular personality types are more likely to develop depression, the vast majority of people who develop the condition have been previously healthy and led normal lives.

People with depression can just 'snap out of it' or just choose to 'pull their socks up'

NOT TRUE One of the most disabling symptoms of depression is the fact that it saps the will and makes doing anything an enormous effort. Depression is an extremely unpleasant experience, and most people with this condition would (and do) do anything to get well. Children and young people will not “grow out of it” and it is not just a phase.

What causes depression?

The exact cause of depression is not known. Children who are very sensitive or anxious are more likely to develop depression. Many things can be considered as factors that make young people and children vulnerable to depression.These include:

• Stressful events like the break-up of parents, or loss of a loved one
• A family history of depression
• Relationship break-ups or problems with friends
• Learning difficulties
• Stressful events in childhood can lead to depression later in life
• Certain medications can cause depression in some people
• Social isolation, i.e., having no friends or family that they feel connected to.

Signs to look for (symptoms)

Symptoms of depression usually develop over days or weeks, though you may have a period of anxiety or mild depression that lasts for weeks or months beforehand.

Depression in children and young people is different from depression in adults, and they may be more irritable and rebellious than sad. Children, especially, may not be able to express in words how they are feeling because of their age. Signs to look for in a young person or child include:

• Irritable mood. This may be the main mood change, especially in younger people.
• Persistent low, sad or depressed mood. The young person may be miserable and unable to cope with daily activities.
• Loss of interest and pleasure in usual activities. This is a reduced ability for enjoyment. It includes loss of interest in sex in adolescents.
• Change in sleeping patterns. Most commonly reduced sleep, with difficulty getting to sleep, disturbed sleep, and/or waking early and being unable to go back to sleep. 
• Change in appetite. Most often people do not feel like eating. Some people have increased appetite, often without pleasure in eating. This is often seen in those who also sleep more.
• Decreased energy, tiredness and fatigue. These feelings may be so severe that even the smallest task seems too difficult to finish.
• Physical slowing or agitation often comes with severe depression. The young person may sit in one place for periods and move, respond and talk very slowly; or they may be unable to sit still, but pace and wring their hands. 
• Thoughts of worthlessness or guilt and, as a result of feeling bad about themselves, children and young people may withdraw from doing things and from contact with others.
• Thoughts of hopelessness and death. The young person may feel there is no hope in life, wish they were dead or have thoughts of suicide.
• Difficulty in thinking clearly and concentrating. They may not be able to read a book or watch television. They may also have great difficulty making even simple everyday decisions.

How the doctor determines if your child has depression (diagnosis)

There are pen and paper tests for depression. However, usually a diagnosis is made by the doctor or clinical psychologist based on whether the child or young person has some or all of the typical symptoms, and the length of time they have had them.

For this reason it’s important that your doctor spends time with you and your child to get a full understanding of the difficulties they have had. While depression could be responsible for the symptoms listed above, the same picture can be seen with the depressed phase of bipolar affective disorder and also in some medical conditions. This is why it’s important your doctor excludes these conditions.

Note: Over the age of 16, young people are treated as adults in terms of consent for assessment and treatment. Below this age, caregivers (usually parents, but sometimes organisations such as Child Youth and Family Services when children are in care) have legal responsibility, and for consenting to any treatments the child may receive. 

Treatment options

Depression can be effectively treated, and people will usually recover from it. The earlier effective treatment is started, the better the chance of recovery. If you think you or someone you know is depressed, look for the signs and talk to them. Your support is important.

Treatment of depression can involve a number of aspects, each of which can be tailored to a child’s individual need. For most, a combination of medication and talking therapies such as counselling can be effective.

Medication

The doctor may prescribe antidepressants. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person. Doctors are usually very careful when prescribing for young people. If your child is prescribed medication they and you are entitled to know:

• the names of the medicines
• what symptoms they are supposed to treat
• how long it will be before they take effect
• how long you will have to take them for and what their side effects (short and long-term) are. 

It’s really important to tell the doctor or counsellor if your child stops taking the medication – a sudden stop can make the person taking it feel bad. If your child is considering stopping medication talk to your doctor and work together with them to find some compromise that will ensure continuing wellness but address their concerns about the treatment.  

Therapy, such as talking therapies

Supportive counselling is a treatment for milder forms of depression, where it is as effective as antidepressant medication.

Other effective therapies are more specific, eg, cognitive behaviour therapy (CBT). Your doctor will explain what is available locally and which type of talking treatment is most suitable for your child or teenager. Medication and therapy can be helpful for many people.

Remember, if you are experiencing depression and are at school you can talk to:

• School guidance counsellor
• Your doctor and talk about a referral to Child and Adolescent Mental Health Services (CAMHS)
• Your Hauora Youth mental health worker. Some areas in New Zealand have services for Maori, Pasifika and Asian youth – ask your school counsellor.

Complementary therapies 

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

When considering taking any supplement, herbal or medicinal preparation you should consult your doctor to make sure it's safe and will not harm your health, for example, by interacting with any other medications.

Physical health

Taking care of your child's general health by making sure they eat well, get enough sleep and exercise are really important to help them through depression or anxiety.

Thanks to Janet Peters, registered psychologist, for reviewing this content. Date last reviewed: September, 2014.