Depression in Children and Adolescents - Depression Causes, Diagnosis and Treatment in Children and Adolescents

Written by Robert Myers, PhD

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What Can We Expect From Treatment?

Treatments for depression are well-defined and effective for the vast majority of those with the illness. Teachers, or a pediatrician or other health care provider, often are the first to put a name to the changes in a child's behavior that are seen with depression. Your child's doctor can rule out the presence of general medical illnesses that might present with some depressive symptoms and, in some instances, may be willing and capable of treating depression. Often, however, seeking specialty care is advisable.

A mental health professional can verify a suspected diagnosis and help a parent and child understand the array and benefits of different treatment options.

Ideally, a treatment program will combine psychotherapy and medications. The former relies on age-appropriate communication as a tool for bringing about changes in a patient's feelings or behavior. While different types of therapies tend to be offered in various communities, research has shown that "here and now" approaches that concentrate on solving problems (rather than on gaining insight into psychological processes) are preferable.

Two specific forms of therapy, cognitive behavioral therapy, and interpersonal therapy, have now have been validated by research to be effective in treating depression in youth.

Parents should be encouraged to ask a therapist specific questions up front: for example, how frequently and over what period of time will therapy take place; whether sessions will involve the depressed child alone, or others in the family also; and how the therapist will assure confidentiality to a child or teenager without locking parents out of the process.

Antidepressant medications target chemical imbalances in the brain that are associated with depression. Several antidepressants introduced in recent years have little potential risk for dangerous overdosing or adverse effects, and are quite effective in adults. Recent studies indicate that these medications can be useful in treating youth depression as well. Additional studies are ongoing in order to further define the efficacy of these medications in children and adolescents.

Parents should ask the physician for details about the purpose of a medication; how long it will take to exert therapeutic action; the frequency with which the physician will evaluate the effects of the treatment and need for dosage changes; and any precautions (for example regarding diet, exercise, side effects) to keep in mind. The child or teen patient should also have age-appropriate information about the medications.

Finding a Mental Health Care Clinician

A child's pediatrician or other primary health care provider as well as school teachers and counselors are key sources for potentially recognizing mental disorders in children and adolescents. With input and support from a child psychiatrist or child psychologist, primary care providers may treat depression, particularly given the availability of increasingly safe anti-depressant medications. But for primary care physicians, especially, time needed to talk to a child and adolescent and his or her family often is limited. Likewise, a specialist's (e.g., a child psychiatrist) input and guidance on medication issues may be needed.

If referral to a mental health specialist is sought, psychiatrists, psychiatric nurses, psychologists, and psychiatric social workers all are qualified to provide mental health care to the extent that they are licensed, or certified. Only psychiatrists, who are physicians, can prescribe medications, however. Ideally, the mental health specialist should be trained to work with children and adolescents.

Antidepressant & Antianxiety Medications

Anafranil	clomipramine	10 and older (for OCD)
BuSpar	buspirone	18 and older
Effexor	venlafaxine	18 and older
Luvox (SSRI)	fluvoxamine	8 and older (for OCD)
Paxil (SSRI)	paroxetine	18 and older
Prozac (SSRI)	fluoxetine	18 and older
Serzone (SSRI)	nefazodone	18 and older
Sinequan	doxepin	12 and older
Tofranil	imipramine	6 and older (for bedwetting)
Wellbutrin	bupropion	18 and older
Zoloft (SSRI)	sertraline	6 and older (for OCD)

In 2004, after a thorough review of data, the Food and Drug Administration (FDA) adopted a "black box" warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the agency extended the warning to include young adults up to age 25. A "black box" warning is the most serious type of warning on prescription drug labeling. The warning emphasizes that children, adolescents and young adults taking antidepressants should be closely monitored, especially during the initial weeks of treatment, for any worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations.

Useful Articles:

Major Depression in Children and Adolescents

Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families

Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers

Antidepressants for Children: Explore the Pros and Cons

Understanding Your Teenager's Emotional Health

What a Difference a Friend Makes: Social Acceptance Is Key to Mental Health Recovery

Resilience Guide for Parents & Teachers

Find Help:

Find a Psychologist

Find a Child Psychiatrist

Help for Families: A Directory of Advocacy and Support Groups for Youth with Emotional, Developmental and Behavioral Disorders