Depression in Children (cont.)
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Depression in children facts
- What is childhood depression?
- What are the types of depression in children?
- What are causes and risk factors for depression in children?
- What are the symptoms and warning signs of depression in children?
- How do health-care professionals diagnose depression in children? Who are specialists?
- What should parents do if they suspect that their child is depressed?
- What is the treatment for depression in children?
- What are complications of depression in children?
- What is the prognosis for depression in children?
- Is it possible to prevent depression in children?
- Where can families get information and support for childhood depression?
- Find a local Psychiatrist in your town
What should parents do if they suspect that their child is depressed?
Family members and friends are advised to seek mental-health assessment and treatment for the depressed child. Family members may confer with the child's primary-care doctor or seek mental-health services by contacting one of the resources indicated below. Once the child with depression is receiving treatment, family members can promote good mental health by gently encouraging him or her to have a healthy lifestyle, including encouraging the child to maintain a healthy diet, get enough sleep, exercise regularly, remain socially active, and to engage in healthy stress-management activities. Loved ones can also be helpful to the depressed child by discouraging him or her from engaging in risky behaviors.
What is the treatment for depression in children?
If it is determined that your child is suffering from clinical depression, the health-care professional likely will recommend treatment. Treatment may include alleviating any medical condition that causes or worsens depression. For example, a person who is found to have low levels of thyroid hormone might receive hormone replacement with levothyroxine (Synthroid). Other aspects of treatment may include supportive therapy, like lifestyle and behavioral changes, psychotherapy, complementary treatments, and may possibly medication for moderate to severe depression. If symptoms are severe enough that treatment with medication is appropriate, symptoms tend to improve faster and for longer when medication is combined with psychotherapy.
Most mental-health professionals will continue treatment of major depression for six months to a year to prevent a reoccurrence of symptoms. Treatment for children with depression can have a significantly positive effect on the child's functioning with peers, family members, and at school. Without treatment, symptoms tend to last much longer, may not improve, or may worsen. With treatment, the chances of recovery are significantly improved.
Psychotherapy ("talk therapy") is a kind of mental-health counseling that entails working with a trained therapist to figure out ways to solve problems and cope with depression. It can be a powerfully effective intervention, even resulting in positive biochemical changes in the brain. Two major kinds of psychotherapy are commonly used to treat childhood depression: interpersonal psychotherapy and cognitive behavioral therapy. In general, these forms of treatment take weeks to months to complete and has a goal of alleviating depressive symptoms. More intensive psychotherapy may be needed for longer when treating very severe depression or for depression that is accompanied by other psychiatric symptoms.
Interpersonal therapy (IPT): This form of psychotherapy seeks to alleviate depressive symptoms by helping child with depression develop more effective skills for coping with their emotions and relationships. IPT uses two strategies to achieve those goals:
- Educating the child and family about the nature of depression: The therapist will reassure the child and his or her family that depression is a common illness and that most people tend to improve with treatment.
- Defining problems (such as abnormal grief or interpersonal conflicts): Once problems are defined, the therapist can help the child set realistic goals for solving these problems and work with him or her and the child's family using different treatment techniques to reach these goals.
Cognitive behavioral therapy (CBT): This approach to psychotherapy helps to decrease depression and the likelihood it will come back by helping the child change his or her way of thinking about certain issues. In CBT, the therapist uses three techniques to achieve these goals.
- Didactic component: This phase helps to establish positive expectations for treatment and promote the child's participation in treatment.
- Cognitive component: This promotes identifying the thoughts and assumptions that play a role in the child's behaviors, especially those that may predispose the sufferer to being depressed.
- Behavioral component: This uses behavior-modification methods to teach the child more effective ways of dealing with problems.
The most commonly used group of antidepressant medications prescribed for children is the selective serotonin reuptake inhibitors (SSRIs). SSRI medications influence the levels of serotonin in the brain. For many prescribing professionals, these medications are the first choice because of the significant degree of effectiveness and safety of this group of medicines. Examples of these medications are listed here with the generic name first and the brand name in parentheses.
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Vortioxetine (Brintellix)
Only Prozac and Lexapro are approved by the Food and Drug Administration (FDA) to treat childhood depression and only in those 8 years of age and older. Any other medications used to treat this condition in children, or using an antidepressant in younger children is therefore considered to be being used "off label."
Although FDA approved for use in teenagers with schizophrenia rather than for depression, atypical neuroleptic medications like aripiprazole (Abilify) and risperidone (Risperdal) are sometimes prescribed in addition to an antidepressant in children who either suffer from severe depression, fail to improve after receiving a trial of an antidepressant in addition to, or instead of, an antidepressant in children who have bipolar disorder.
Non-neuroleptic mood-stabilizer medications are also sometimes prescribed with an antidepressant to treat children with severe unipolar depression who do not improve after receiving trials of different antidepressants. These medications might also be considered in addition to or instead of an antidepressant in children who suffer from bipolar disorder.
Examples of such non-neuroleptic mood stabilizers include divalproex sodium (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal). Of the non-neuroleptic mood stabilizers, lamotrigine (Lamictal) seems to be unique in its ability to also treat unipolar depression effectively by itself as well as in addition to an antidepressant. However, it is only used in people 16 years of age or older due to potentially serious side effects.
Learn more about: Lamictal
Other antidepressant medications work differently than the commonly used SSRIs. The following medications might be prescribed when SSRIs have not worked: bupropion (Wellbutrin), venlafaxine (Effexor), duloxetine (Cymbalta), or desvenlafaxine (Pristiq).
About 60% of children who take antidepressant medication improve and are thought to be highly suggestible to improve (placebo effect). It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. The prescribing professional will likely assess the depressed child that is receiving the medication again soon after it is started to determine if the medication is being well tolerated and if symptoms have begun to improve. If not, the doctor might adjust the dose of the medication or prescribe a different one.
After symptoms start to improve, the prescribing health-care professional will likely encourage the family of the depressed child to continue giving the medication for six months to a year because stopping the medication too soon may result in symptoms returning or worsening. Some people need to take the medication for longer to prevent the depression from returning. Stopping treatment abruptly may cause the depression to return or for withdrawal effects (discontinuation syndrome) to occur, depending on which medication is being prescribed.
Side effects of antidepressant medications vary significantly from drug to drug and from person to person.
- Common side effects can include dry mouth, upset stomach, nausea, tremor, insomnia, blurred vision, constipation, and dizziness.
- In rare cases, some people of all ages have been thought to have become acutely more depressed when on the medication, even attempting or completing suicide or homicide. Children and teenagers are thought to be particularly vulnerable to this rare possibility. However, when considering this risk, it is imperative to also consider the risk of the possibly serious outcomes that can result from untreated depression.
A number of nonprescription herbal supplements like St. John's wort and dietary supplements like vitamin C and B complex vitamins are used to treat depression. There is little known about the safety, effectiveness, or appropriate doses of these remedies, despite their being taken by thousands of people around the world.
- While some of the best-known alternative remedies continue to be studied to see how well they work, there remains little evidence that herbal remedies effectively treat moderate to severe clinical depression.
- Medical professionals are often hesitant to recommend herbs or dietary supplements to treat depression, particularly in children, because they are not regulated by the FDA, as prescription drugs are, to ensure their purity, quality, and effectiveness.
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