If your child is depressed, you're probably frightened and frustrated because depression can be scary for your child and discouraging if you're a parent who's at a loss to help.

You want to put your protective arms around your child and make her whole again. Or instead of hugging her, maybe you want to tell her to get a grip, to snap out of it.

But depression isn't something a person can just snap out of and it's much more than a bad mood that will eventually go away. Although your child's condition may seem unshakable right now, her depression is a treatable illness with definite symptoms and effective treatments. Here's the good news: you can help your child by getting her the help she needs.

Getting Help for Your Child
Your first consultation should be with your child's doctor, who probably will perform a complete examination to rule out physical illness. If depression is suspected, he or she may refer you to a psychiatrist (a medical doctor who can make a diagnosis, offer treatment, and may prescribe medicine); psychologist (a health professional who can diagnose and treat depression but is unable to write prescriptions); or licensed clinical social worker (a person who has a degree in social work and is qualified to treat childhood depression).

When it comes to managing your child's depression, all of these health professionals can help. The important thing is that your child feels comfortable with the therapist. If it's not a good fit, find another.

Your child's teacher, guidance counselor, or school psychologist also may be able to help you. These individuals may be first to notice the change in your child, and they may be first to alert you to the problem. It's important to remember that these professionals have the welfare of your child at heart and that the information you and your child reveal to them during therapy is kept in strict confidence.

Treating Depression
Don't put off your child's treatment. Early detection and diagnosis are key in treating children with depression. A child or adolescent psychiatrist or psychologist can perform a complete diagnostic evaluation. Your child's treatment plan may include counseling, medicine, or a combination of both. Family intervention also may be helpful: the best outcome often is achieved when the entire family works together with the child in therapy sessions. Depending on your child's age and maturity, it also may be beneficial if your child is involved in treatment decisions and takes responsibility for her own wellness.

The most common and effective antidepressants are the SSRIs (selective serotonin reuptake inhibitors), including fluoxetine, sertaline, paroxetine, and fluvoxamine. It may take some time to find the right medicine and dosage for your child. The side effects of these SSRIs are mild and may occur in 2 or 3 weeks after beginning medication therapy.

Because depressed children often are critical of themselves and their worlds, cognitive therapy is especially effective in helping to change the way they think of themselves. Cognitive therapy teaches children to look for connections between thoughts and actions and to challenge negative thoughts. For example, if your child thinks to herself, "I'm a bad person," she would then ask herself for evidence. Most of the time, there is no evidence or proof to back up these negative thoughts; it's simply the way the child perceives herself. Once she realizes what she's doing, she may be able to think more positively.

Studies show that the average duration of a depressive disorder is 6 to 8 months, but statistics vary from child to child, and a full recovery may take years. Ignoring depression can be dangerous because the illness can affect your child's social skills, as well as her concentration, energy level, and relationships with family and friends. Because your child doesn't like herself, it can be hard for others to like her. This disruption in social development can have lifelong effects if untreated.

What Can I Do to Help?
Most parents think that it's their job to ensure the happiness of their child. When your child's depressed, you may feel guilty because you can't cheer her up. You also may think that your child's suffering because of something you did or didn't do. This isn't true. If you're struggling with guilt, frustration, or anger, you may want to consider counseling for yourself. In the long run, this can only help - both you and your child.

Other ways to help:

• Become an expert on depression. This way, you'll know what to expect and how to cope.
• Make sure your child takes her medicine and encourage her to eat right, too, as this may help her feel better physically as well as improve her mood and outlook. Physical activity also has been shown to help alleviate the symptoms of depression. Incorporate physical activities, such as bike rides or walks, into your family's routine.
• Let your child know that you're there for her, that you love and care about her, and that you want to hear what she has to say, even if it isn't pleasant. Although these things may be difficult for your child to believe, it's important to say them. Eventually, they'll be acknowledged.
• Accept your child's behavior. Never tell your child to "snap out of it." Remind yourself that she's not being lazy because she can't get out of bed, won't clean her room, or do her homework. She simply doesn't have the desire or the energy.
• Take care of yourself. Remember that even though it's your child who's suffering, it's OK to step away from the situation for a while. Have dinner with a friend or go to a movie. Do something for yourself.

Ignoring depression can have deadly consequences: the number-one cause of suicide is untreated depression. If your child talks about suicide, to you or anyone else, or shows warning signs such as giving belongings away and being preoccupied with death, call your child's doctor or mental health professional immediately.

Reviewed by: Paul Robins, PhD
Date reviewed: May 2001

Your daughter spends more time in her room than usual, with the door closed and the shades drawn. She sleeps a lot, and even the family dog can't make her smile anymore. She has stopped hanging out with her friends, and when you ask what's going on, she just mumbles.

Normal teen behavior? Not really. There's more here than meets the eye, something that's telling you things are not right.

It's possible that your child is depressed. In the United States, depression is the most common mental health disorder, affecting 17 million people of all age groups, races, and economic backgrounds each year. As many as one in every 33 children may have depression; in adolescents, that number may be as high as one in eight. If you suspect that your child is depressed, you'll want to learn more about what depression is, what causes it, and what you can do if your child is depressed.

What Is Depression?
Depression isn't just bad moods and occasional melancholy. It's not just feeling down or sad, either. These feelings are normal in children, especially during adolescence. Even when major disappointments and setbacks make people feel sad and angry, the negative feelings usually lessen with time. But when a depressive state, or mood, lingers for a long time - weeks, months, or even longer - and it limits a child's ability to function normally, it can be diagnosed as depression.

Two types of depression, major depression and dysthymia, can affect children. Major depression is characterized by a persistent sad mood and the inability to feel pleasure or happiness. A child with major depression feels depressed for most of the day, almost every day.

If the sadness is not as severe but continues for a year or longer, the condition may be dysthymia.

Bipolar disorder is another type of mood disturbance and is characterized by episodes of low-energy depression (sadness and hopelessness) and high-energy mania (irritability and explosive temper).

What Causes Depression?
Depression usually isn't caused by one event or thing; it's the result of one or more factors, and its causes vary from child to child. Depression can be caused by lowered levels of neurotransmitters (chemicals that carry signals through the nervous system) in the brain, which limits a person's ability to feel good. Depression can run in families, so a child who has a close relative with depression may be more likely to experience it herself.

Significant life events such as the death of a loved one, a divorce, a move to a new area, and even a breakup with a girlfriend or boyfriend can bring on symptoms of depression. Stress also can be a factor, and because the adolescent years can be a time of emotional and social turmoil, things that are difficult for anyone to handle can be devastating to a teen.

Also, chronic illness can lead to depression, as can the side effects of certain medicines or infections.

Diagnosing Depression
Depressed children have described themselves as feeling hopeless about everything or feeling that nothing is worth the effort. They honestly believe that they are "no good" and that they're helpless to do anything about it.

But for an accurate diagnosis of major depression to be made, a more detailed clinical evaluation must be done. A medical or mental health professional (such as a psychologist or psychiatrist) must be sure that your child has had five or more of the following symptoms for more than 2 weeks:

• a feeling of being down in the dumps or really sad for no reason
• a lack of energy, feeling unable to do the simplest task
• an inability to enjoy the things that used to bring pleasure
• a lack of desire to be with friends or family members
• feelings of irritability, anger, or anxiety
• an inability to concentrate
• a marked weight gain or loss (or failure to gain weight as expected), and little or too much interest in eating
• a significant change in sleep habits, such as trouble falling asleep or getting up
• feelings of guilt or worthlessness
• aches and pains even though nothing is physically wrong
• a lack of caring about what happens in the future
• frequent thoughts about death or suicide

A child who has dysthymia must experience two or more of the following symptoms almost all the time for at least 1 year:

• feelings of hopelessness
• low self-esteem
• sleeping too much or being unable to sleep
• extreme fatigue
• difficulty concentrating
• lack of appetite or overeating

Depressed children and teens are more likely to use alcohol and drugs than those who aren't depressed. Because these substances can momentarily allow a child to forget about her depression, they seem like perfect "fixes." But they don't fix anything; in fact, they can make the depressed child feel even.

Recognizing Depression in Your Child
If you've discovered that more than a few of the symptoms of major depression or dysthymia apply to your child, you may have reason for concern.

Don't dismiss your concerns or think that the symptoms will go away by themselves - they probably won't, and they may get worse. And don't think that you're responsible for your child's depression - even if something you did (such as a divorce) triggered it, it's not your fault. It's nobody's fault.

Let your child know that you are there for her, whenever she needs you and wherever you may be. Remind your child of this over and over again - she may need to hear it a lot because she feels unworthy of love and attention. If your child shuts you out, don't walk away - remain there for her. Once your child begins to talk, let her talk about whatever she wants to talk about and don't criticize. The important thing is that she's talking and communicating her feelings. This will help your child begin to realize that her feelings and thoughts really do matter, that you truly care about her, and that you never stopped caring even when she became depressed.

If You Suspect a Problem
The good news is that there are professionals who can help your child. Depression can be successfully treated in more than 80% of the people who have it. But if it goes untreated, depression can be deadly. Depression is the number-one cause of suicide.

Depression is commonly treated with a combination of therapy and medicine. A psychiatrist can prescribe medicine, and although it may take a few tries to find the right one for your child, most children who follow the regimen eventually begin to feel better. Therapy focuses on the causes of the depression and works to help change negative thoughts and find ways to allow your child to feel better. Feeling is healing, and talking about feelings can be a powerful antidote for depression. A good therapist will communicate this to your child.

With proper treatment and your help, your child can lead a normal, happy, and fulfilling life.

Reviewed by: Paul Robins, PhD
Date reviewed: May 2001