Understanding depression in children and young people
Written by:Children and young people can also experience depression, just like adults. In the UK, depression occurs in 2.1% of children and young people aged 5-19.
Here, Dr Lokesh Bisati, renowned consultant child and adolescent psychiatrist based in Chelmsford, provides an expert insight into depression in children and young people.
What is depression?
Depression is a mental health condition characterised by persistent and pervasive feelings of sadness and hopelessness. The condition can impact all areas of life, affecting thoughts, emotions, behaviour, and physical wellbeing.
The common types of depression that affect children and young people include:
- Major depressive disorder (MDD): This is the most common type of depression. Children and adolescents who have MDD experience persistent feelings of sadness, hopelessness, and a loss of interest in activities they once enjoyed. Symptoms can be severe and may interfere with daily functioning.
- Persistent depressive disorder (PDD): Also known as dysthymia, PDD is characterised by milder but long-lasting symptoms (at least a year) of low self-esteem, lack of appetite, and low energy.
- Bipolar depression: Bipolar disorder is a mental health condition characterised by alternating cycles of depression and episodes of mania or hypomania. During depressive episodes, children and young people who have bipolar disorder may have feelings of sadness and guilt, a lack of interest in activities, changes in appetite, fatigue, and suicidal thoughts.
- Seasonal affective disorder (SAD): SAD occurs during certain seasons, such as the winter months when there is less natural sunlight. SAD can lead to symptoms like sadness, fatigue, sluggishness, and changes in appetite and sleep.
Recognising the signs of depression in children and young people is essential for early intervention and support. However, it’s important to know that depression in these age groups may present differently compared to adults. Specific symptoms and their severity may also vary from patient to patient.
Symptoms of depression in children and young people often include:
- persistent sadness and hopelessness
- irritability, agitation, or anger outbursts
- changes in sleep, such as insomnia or hypersomnia (excessive sleeping)
- a lack of interest in activities, such as hobbies and sports
- fatigue and low energy levels
- self-harm or suicidal thoughts
Additionally, symptoms may also include:
- self-criticism and feelings of guilt
- feeling empty or numb
- changes in appetite
- weight loss or weight gain
- difficulty concentrating and making decisions
- a decline in academic performance or reluctance to attend school
- risky behaviour or substance misuse
Some children and young people may try to hide their feelings or may not be able to articulate their emotions effectively. Others may also have physical symptoms like headaches and stomach pain.
How is depression clinically diagnosed in children and young people?
The clinical diagnosis of depression is based on a structured assessment process carried out by mental health specialists, where established diagnostic criteria is used to determine if a patient’s symptoms meet the criteria for depression.
There are different stages involved:
- Initial consultation: During the consultation, the specialist will conduct a mental health assessment and interview the patient, and the patient’s parents and teachers. This information will help the specialist to understand the impact of depression, and the patient’s symptoms and overall health.
- Ruling out of other conditions: It’s important to rule out other medical conditions that can mimic or co-exist with depression, such as bipolar disorder, anxiety disorder, and other mental health conditions. This is done to ensure the patient’s symptoms aren’t caused by an underlying condition.
- Assessment tools: As part of the assessment process, the specialist may use standardised assessment tools or questionnaires designed to screen for and assess the symptoms of depression. These tools can provide additional insights into the duration of the symptoms and their impact on daily functioning.
For a clinical diagnosis of depression, symptoms must be present every day, nearly all day, for at least two weeks, and significantly affect daily functioning. An accurate clinical diagnosis of depression is the first step towards an effective treatment plan.
What are the different treatment options available for depression in children and young people?
Treatment for depression is highly individualised. It’s thus important to consult with a specialist to determine the most appropriate treatment plan, which will involve a combination of therapies and support services, all tailored to the patient’s specific needs.
The different treatment options available for children and young people include:
Psychological therapies
- Cognitive behavioural therapy (CBT): CBT is an essential component in the treatment of depression that can help children and young people to identify and change negative thought patterns and behaviours. It can be delivered in individual or group sessions.
- Family therapy: Family therapy involves the entire family in the treatment process, which is vital for the recovery process for cases of depression in children and young people.
- Play therapy: This approach is primarily used for younger children. Play therapy allows children to express their feelings and experiences through play, providing a non-verbal outlet for emotions. As well as play therapy, some children may benefit from complementary therapies such as art therapy, music therapy, or mindfulness practices.
Medication
Medication is considered when depression is severe, persistent, or not responsive to psychological therapies alone.
Antidepressant medications are commonly prescribed. These medicines work by balancing the levels of the neurotransmitters in the brain that play a key role in regulating mood, helping treat the symptoms of depression.
For example, selective serotonin reuptake inhibitors, which are a typically-used class of antidepressants that increase the levels of serotonin in the brain by blocking the reuptake of serotonin by nerve cells. This leads to higher serotonin levels in the synaptic cleft, which can help regulate mood and alleviate symptoms of depression.
The use of medication in children and young people should be carefully considered, and only made after a complete mental health assessment by a specialist. Patients who take antidepressants will need regular check-ups with a specialist.
Lifestyle changes
Encouraging a healthy lifestyle is essential. This includes maintaining a balanced diet, regular exercise, and ensuring adequate sleep.
The choice of treatment is determined by a mental health specialist based on the individual needs and circumstances of the patient. It’s essential for parents to work closely with the specialist to develop an effective, personalised, and comprehensive treatment plan for their child.
How can families build a support system for children and young people who have depression?
Building a strong support system for children and young people who have depression is crucial for their mental wellbeing and recovery. Recovery from depression is a gradual process, and parents should be patient and understand that there will be ups and downs.
Parents should encourage open, honest and non-judgmental communication, listening actively and empathetically, and letting their child know that they can talk about their feelings without fear. Efforts should be made to reduce family conflicts and maintain open communication.
In addition, parents should also learn about depression, the symptoms of depression, and how depression is treated, to better understand the condition and what they can do to provide support. The more parents understand, the better equipped they’ll be to support their child.
Routines and healthy habits should also be established, including a balanced diet, physical activity, and adequate sleep. Parents should gently encourage their child to reinforce social connections by maintaining contact with friends and other family members, as well.
At school, parents should inform their child’s teachers about their depression and work with the academic staff to develop support services. The child’s academic progress should be adjusted for any necessary accommodations.
Parents should also regularly check in with their child, asking about their emotional wellbeing and their feelings towards treatment. If a child or adolescent is expressing suicidal thoughts or thoughts of self-harm, it’s important to seek medical help immediately.
Each child and adolescent is unique, and a support system should always be tailored to specific needs and circumstances. Seeking help from a specialist can be useful to guide parents on how to provide the best support and care for their child.
Dr Lokesh Bisati is a highly regarded consultant psychiatrist with over 15 years’ experience.
If your child is living with symptoms of depression, don’t hesitate to reach out to Dr Bisati via his Top Doctors profile today to receive expert diagnosis, treatment and support.
