Depression is a serious mood disorder that can take the joy from your child's life. It may occur when brain chemicals that affect your child's mood get out of balance. Stress, family problems, or trauma such as violence, abuse, or neglect can cause this to happen.
Depression runs in families. Children and teens who have a parent with depression are more likely to have depression than children whose parents are not depressed. As many as 2 out of 100 children and 8 out of 100 teens have serious depression.1
It may be hard to know if your child is depressed or just moody. It's normal for a child to be moody or sad from time to time. It's often just a part of growing up. You can expect these feelings after the death of a loved one or pet, a move to a new city, or a divorce.
But if these feelings last for weeks or months, they may be a sign of depression.
If your child is just moody, he or she probably doesn't need treatment. But if your child is depressed, he or she may need medicine, counseling, or both to feel better.
It may also be hard to know if your child's symptoms are caused by something other than depression. Some medical problems can cause symptoms that look like depression. Your child's doctor may do some tests to help rule out physical problems, such as a low thyroid level or anemia, and other problems such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder.
If your child is depressed, he or she is more likely to:2
Medicines called antidepressants are used to treat depression in children and teens. They can help balance the chemicals in the brain that affect your child's mood, and they can help reduce your child's symptoms.
There are several types of antidepressant medicines. Fluoxetine (Prozac) is usually the first type of antidepressant given. Another SSRI, such as citalopram (Celexa) or sertraline (Zoloft), may be tried if fluoxetine doesn't help your child feel better.
Other medicines may also be used. But the possible side effects of these medicines are more serious than those of SSRIs. These other medicines include:
Your child will take pills or liquid medicine every day for as long as he or she needs them. Your child may start to feel better within 1 to 3 weeks after starting an SSRI. But it can take as many as 6 to 8 weeks to see more improvement. It's important that your child takes the medicine as prescribed and keeps taking it so it has time to work.
If you have questions or concerns about your child's medicine, or if you don't notice any improvement by 3 weeks, talk to your doctor. Your child may need to try several different medicines to find one that works.
Your child's medicine may cause side effects, but they will usually go away within the first few weeks. Common side effects include:
There is also a small chance that your child might think about suicide while taking antidepressants, especially during the first few weeks of treatment.
A combination of fluoxetine and individual counseling often works better than if only one kind of treatment is used. This is especially true if your child's symptoms are severe. One study showed that after 12 weeks of treatment:3, 4
This same study continued to follow these children. At 36 weeks:
Over time, the children were helped equally by the three different treatments. But using both medicine and counseling reduced depression symptoms faster than either medicine or counseling alone.
Some children who are first diagnosed with depression are later diagnosed with bipolar disorder, which has symptoms that cycle between depression and mania. If your child or teen has bipolar disorder, a first episode of mania can happen spontaneously. But it can also be triggered by antidepressants. That is why it is very important to tell your child's doctor about any family history of bipolar disorder and to watch your child closely for signs of manic behavior.
FDA advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, people taking antidepressants should be watched for warning signs of suicide, such as saying they are going to hurt themselves, talking or writing about death, or giving away their things. This is especially important at the beginning of treatment or when doses are changed.
Studies by the FDA have found that:
If your child's symptoms are mild to moderate, counseling or lifestyle changes may be enough to help your child feel better.
There are different types of counseling that may help your child.
Here are some things that you can do at home to help your child feel better:
Your doctor may advise that your child take medicine for depression if:
|Have your child take medicine for depression||Don't have your child take medicine for depression|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"Tyler has always loved playing soccer, has had a lot of friends, and his grades have been average. Since starting junior high school, though, Tyler has decided he is not good enough to play soccer and he quit the team. He doesn't hang out with the friends he used to have in grade school, is irritable most of the time, and prefers to be alone. Sometimes he still jokes around with his younger brothers and is able to laugh with them at pranks they pull on one another. His grades have slipped a little, but he does do his homework daily. At a routine checkup, his mother asked our doctor whether Tyler could be depressed. After asking Tyler a few questions, the doctor said he didn't think so, but he recommended that we watch him for further signs of depression. We've encouraged him to join a few after-school activities. For now, we're taking a wait-and-see approach."
— Neal, father of Tyler, age 13
"Sarah has gone from an outgoing, happy child to a quiet child who worries about everything. If Sarah is not crying, she is irritable and moody. She has stopped all interest in her favorite hobbies and doesn't seem to enjoy anything in her daily life. She sleeps a lot and has gained more than 10 pounds over the past month. She's been acting this way for around 6 months. I took Sarah to a child counselor, who said she has mild to moderate depression. The counselor recommended that Sarah try an antidepressant along with the counseling to try to improve her mood and lessen the impact of the depression. I think the medication might help, and Sarah is willing to try one or two medicines until the right one is found."
— Tisha, mother of Sarah, age 11
"After Heather broke up with her boyfriend, she cried all the time. She has a lot of friends who called to console her. She thought that if she could only get his attention, the boyfriend would want her back. My wife caught Heather going through our medicine cabinet looking for pills that might make her sick, so we took her to the doctor who recommended a therapist. Heather is seeing the therapist, but we've decided not to put her on medicine. We think her problem came from this one situation with the boyfriend, and after she learns some new coping skills, we hope she'll be better able to handle future disappointments."
— Adrien, father of Heather, age 16
"Jerome got caught smoking at school, and I suspected he had been drinking alcohol. Jerome was arguing with his teachers and with me and said no one understands him. He would listen to music with angry lyrics or sit alone in his room in the dark. I found a list Jerome wrote identifying who should get his things should something happen to him. I dragged him to a counselor, as he didn't want to go. The counselor said Jerome was severely depressed. His father had been diagnosed with depression several years ago. After a few sessions with the counselor, Jerome agreed to try an antidepressant. His dad and I will help him stay on his medicine schedule for as long as it takes for Jerome to get better."
— Lasandra, mother of Jerome, age 15
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons for your child to take medicine for depression
Reasons for your child not to take medicine
My child wants to try medicine.
My child doesn't want to try medicine.
My child's depression isn't improving with counseling alone.
I want my child to continue counseling, without medicine, at least for a while.
I'm worried that depression is affecting my child's schoolwork and relationships with friends and family.
My child's schoolwork and relationships with friends and family don't seem to be affected.
I'm concerned that my child might try alcohol or drugs to feel better.
I'm not concerned that my child might try alcohol or drugs to feel better.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
My child taking medicine
My child NOT taking medicine
1. Counseling may be enough to help my child feel better.
2. If my child's symptoms are severe, he or she just needs to take medicine to get better.
3. I shouldn't worry if my child has been moody or sad for weeks.
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||John Pope, MD - Pediatrics|
|Specialist Medical Reviewer||David A. Axelson, MD - Child and Adolescent Psychiatry|
Wagner KD, Brent DA (2009). Depressive disorders and suicide. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3652–3663. Philadelphia: Lippincott Williams and Wilkins.
American Academy of Child and Adolescent Psychiatry (2007). Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11): 1503-1526.
March JS, et al. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) Randomized Controlled Trial. JAMA, 292(7): 807–820.
Reinecke MA, et al. (2009). Findings from the Treatment for Adolescents with Depression Study (TADS): What have we learned? What do we need to know? Journal of Clinical Child & Adolescent Psychology, 38(6), 761–767.
Bridge JA, et al. (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials. JAMA, 297(15): 1683–1695.