Depression in children and teenagers
Depression in children and adolescents may not look the same as depression in adults. It can affect children of all ages. You may notice a child becoming quieter and more withdrawn than she used to be, or not wanting to engage in activities she once took pleasure in.
Another sign that a child or teenager may be experiencing low mood is persistent negative remarks about herself, others or the world. She may put herself down regularly. Viewing life through a negative lens is an unfortunate effect of feeling low, but of course it can also contribute to feeling even more low, creating a vicious cycle.
Some children and teenagers may not become withdrawn or put themselves down. Low mood or depression can present itself as anger and defiance, particularly in younger children. If a child feels low but the world around her carries on regardless (the demands of school, activities, socialising and family life), it is not surprising that she may show anger, defiance or resentment.
Clinically diagnosed depression vs low mood.
Clinical depression is a serious condition. It is very different from low mood. It is diagnosed by a doctor. If your child is depressed she would be likely to be show:
- A depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Low mood can also have a significant effect on a child’s life and upon all the family, and may require intervention from a specialist such as a psychologist. However, if you think your child may have clinical depression, it is important you seek professional help, starting with your GP (general practitioner). Your GP will refer your child to a specialist service.
Low mood and depression as a normal reaction to events
Low mood and depression can be perfectly normal responses. If your child has been bereaved or has gone through another kind of trauma, it may take time to experience pleasure in life again. This can include things we may not consider trauma in the traditional sense, such as bullying, or moving to a different area. The feelings that result from trauma, such as disbelief, confusion, anger, fear of bad things happening again, deep sadness, may combine in a complex way to make a child feel helpless or even hopeless about the future. This can result in depression.
Trauma tends to cloud our enjoyment of once enjoyable activities, because the trauma seems to dwarf everything else and make these things seem trivial or unimportant. Similarly, trauma can lead both children and adults to question some of our basic assumptions about life. For example, where a child once felt safe, if they have had certain kinds of trauma they may no longer feel safe. All of this can contribute to low mood and depression.
The important thing to remember is that the difficult life experience will not always cloud everything else, and have such a heavy influence. There will come a time when things feel more balanced again, and the child or teenager will be able to begin enjoying aspects of life again.
Other common contributing factors to depression in children.
There are a number of reasons why children become low in mood or depressed. Below I have summarised just a few of those I have come across over the years.
Many of the children I have seen over the years with low mood or depression, have been the brightest, most inquisitive children, who are sensitive and very deep thinkers. Deep thinking tends to lead to deep worrying. Children may have multiple levels of worries from the health of their family to climate change.
Feeling of not fitting in or being different
We are social animals, who have always survived by forming communities. Therefore, most of us want to belong to a group as this makes us feel secure, safe and loved. If your child feels she does not have this in an area of her life (such as school), it can have a profound impact on her sense of wellbeing.
Unhelpful “core beliefs”
A single bad event, or multiple smaller events, can lead a child to have an unhelpful belief about herself. For example, a bullying incident can lead a child to believe that “I am not as good as others”. Psychologists call these deep-rooted, fundamental beliefs “core beliefs”. They shape the way we view the world. They must be gradually adapted and weakened over time through experiences which counteract the belief. If a child who has been bullied has lots of family members and friends who adore her, she will eventually begin to believe that she is just as good a person as everyone else.
Family or child facing overwhelming difficulties
Some children face so many real-life difficulties that it can feel like nothing they do will change things, so they feel powerless. This is called “learned helplessness” and it is directly related to low mood and depression. It could be caused by family difficulties, trouble learning in the classroom, friendship issues, or a combination.
Depression in children and teenagers: Strategies for parents
1. Take back control over worry or difficult thoughts
Bad thoughts and worries are not facts. They are mental events which may or may not be true, but nevertheless seem very powerful and real. Research shows that expressing a bad thought or worry can be hugely helpful in reducing the power of the thought. Sit down with your child and encourage them to talk. This must not be done too close to bedtime, when bad thoughts can gain momentum thanks to the dark, quiet, alone time.
Together, figure out which worries or bad thoughts can be controlled or changed. Encourage your child to let the others go, at least for specified times of the day. It is pointless, though completely understandable, to worry about things which cannot be changed. For example, a worry that grandma may die because she is unwell. It is healthiest to try to restrict worry to an hour or so per day: “Worry time”. This allows the brain plenty of worry-free time.
2. Provide extra nurture
Consider this low mood or depression as a temporary state. Feeling low or depressed is often accompanied by feeling unsafe and vulnerable. Your job as a parent (or carer or teacher) is to work extra hard to increase the child’s feelings of safety. This may involve more physical affection, a hot chocolate and a movie, being more understanding about minor behaviour issues, or generally treating your child as if she was a bit younger, just while she’s feeling vulnerable.
3. Encourage “pleasure and mastery” through structure
People who are depressed, often find that they have little energy or motivation to do things they once found enjoyable. This contributes to a vicious cycle. Your child or teen will need help to structure her days and weeks. She should do one or two things each day which are enjoyable or satisfying.
4. Ensure regular social contact
Some people wan to withdraw when they feel low or depressed. If your teenage daughter stops meeting up with her friends, she will not have an opportunity to engage in fun activities and chatter with them, which could help her mood. Children must have some social contact with their peers every day. You may need to support them in arranging this. Be careful about which friends are chosen. It needs to a positive experience that is not too overwhelming.
5. Encourage them to talk or express things creatively
What does your child’s brain feel like to them? Like a knotted ball of wool? Perhaps a prison. If she can draw or create this through art, you will be able to empathise and connect with her more strongly. What does depression feel like in her body? Ask her to draw a body and colour in different areas to help you understand. The more understanding and connected a child feels, the more she is going to feel supported and understood, to enable recovery to begin.
6. Find “flow” activities.
What does your child do that makes her really happy? Be it dancing, football, singing, model-making or reading, flow activities help your child enjoy the “now”. When immersed in an activity which brings joy, a child can focus fully on that emotion, rather than thoughts about the past or future. Just a few minutes a day of flow activities can make a difference.
7. Physical activity
Physical activity lifts mood. It relieves stress, for example by burning off the stress hormone cortisol, and it leads to the production and release of mood-balancing chemicals such as serotonin. Exercise in nature is even better as it allows the senses to connect with calming and awe-inspiring parts of the natural world. Even if it is only 5 minutes, get your child or teenager moving, and try to increase this by a few minutes each day.
8. Seek help for family difficulties wherever possible
Sometimes whole families can feel low in mood and very stuck. If parents have mental health problems, financial difficulties, or difficult life circumstances, the entire family can feel overwhelmed by their difficulties. Children and teens will, of course, feel this too. It is beyond the scope of this article but the first step out of a downward spiral can be a very tiny step, like accepting a very small offer of help from a friend. This may lead to other things and the upward spiral for the family has begun. Help may come form multiple (and sometimes surprising) directions but each small step may help you and your child feel a tiny bit less overwhelmed by what life has thrown at you.
9. Know when and how to seek specialist support
If your child is still managing to engage in most social activities and go to school, you may not need to seek professional help. If in any doubt, talk things through with the GP.
Your child’s GP (general practitioner) should be the first port of call. He or she can advise you further about appropriate local services to support you and your child. This may be the CAMHS (NHS child and adolescent mental health) service in your area.
A clinical or counselling psychologist is someone who listens to your child’s story to understand the full picture. We are experts in working out why someone’s mental health may not be as good as it should be. Psychologists work collaboratively with children and families to change this. We generally offer regular psychological therapy sessions to work towards better mental health. There are a number of “talking therapy” treatment options. Two of the most popular for depression in children are CBT (cognitive behaviour therapy) and CFT (compassion focused therapy). Psychologists may be found in the NHS (for example, as part of the CAMHS team) or independently (you can find a psychologist through AChiPPP – the Association of Child Psychologists in Private Practice.
A psychiatrist is a medical doctor who has done further training in understanding the mind, and can diagnose depression. Psychiatrists can prescribe medication such as anti-depressants. They are often involved in assessing which service is right for a child who is showing risky behaviours. For example someone who has threatened to attempt suicide. It is not common for under 16s to be prescribed anti-depressant medication. Anti-depressants can have difficult side effects and do not solve the root cause of the depression. Sometimes though, medicine may help a child to feel better and more able to access other forms of support.
A&E or emergency GP appointment
If your child has harmed themselves or is threatening immediate harm to themselves, you need medical advice. Do not hesitate to seek emergency help. Depending on the circumstances, you may need to dial 999 or take your child to A& E (accident and emergency), or telephone your GP surgery and explain your urgent concerns.