It is normal for children and youth to feel sad, down or to be in a bad mood from time to time. But a low mood that lasts for more than a few weeks and makes it hard for a child or youth to function at school, with friends or in their daily lives can be a sign of depression, which is a type of mood disorder.

It can be hard for parents, caregivers and other adults to know if a child has depression because it can show up in different ways. It is important to know that depression is a treatable condition.

What causes depression?

There is no single cause of depression and often it is due to a combination of things:

• Genetics. A child or youth is more likely to have depression if there is a history of depression in parents or siblings. Depression often runs in families.
• Environmental factors. If a child or youth experience stress, loss, violence, neglect, abuse or poverty, they are more likely to have depression. Another factor is the changes in seasons, which can lead to Seasonal Affective Disorder (SAD). 
• Psychological vulnerability. Children with low self-esteem, poor coping skills or a negative outlook can have a harder time dealing with their moods.
• Stressors. Problems with school, friends, bullying, or extracurricular activities may be associated with depression.
• Biological. Children with medical conditions such as anemia (low red blood cell count) or thyroid problems can have the same symptoms as depression. Some conditions such as chronic pain may increase the risk of developing depression.

A health care professional can give your child a screen or test for depression. The screen is made up of a number of questions. Many of the signs and symptoms of depression can be a normal part of a child's growth and development. Seeing the whole picture helps to separate depression from normal feelings and behaviours that are age appropriate.

If a child or youth does in fact have depression, the symptoms can range from mild to severe. The behaviour of children and youth with depression may differ from that of adults with depression. Usually, children and youth with depression will have a significant change in their ability to function in school and other places.

Children with depression may:

Thoughts

• have problems with thinking, concentrating or making decisions
• have negative thoughts about most things
• think life is not worth living
• have trouble seeing their own positive qualities and be too critical of themselves
• blame themselves for events that are not their fault

Feelings

• feel sad, unhappy or have low mood most of the time
• feel angry or irritated most of the time
• feel hopeless and think that things will not get better in the future
• feel helpless and think that everything is unfair
• feel like a disappointment or burden to others
• lose interest or enjoyment in activities
• feel guilty
• constantly feel numb, bored or empty
• be unhappy even when good things happen
• be very sensitive to rejection or failure

Behaviours

• often cry or be tearful
• be absent from school often or not perform as well
• have a major change in eating or sleeping patterns
• have a major change in hygiene or appearance
• seem agitated and wring their hands, pace or fidget
• speak or move more slowly than usual
• argue or start fights more often
• withdraw from family and friends
• take part in risky behaviours
• use substances or self-harm to try to feel better

Physical signs

• lose or gain weight without trying
• sleep more or less than usual
• have unexplained physical symptoms, pains or complaints 

What can go along with depression?

Children with depression can also experience other mental health challenges at the same time. This can affect their symptoms, ability to function and treatment options. Some mental health challenges that can exist alongside depression include:

• anxiety
• attention-deficit/hyperactivity disorder (ADHD)
• eating disorders
• substance use challenges
• behavioural disorders

Dealing with these challenges can help with the depression. If children or youth develop these challenges, it is important to reach out for help early so you, your child and your family have all the support you need.

There are many ways to help your child. Depression is one of the most treatable mental illnesses. You can take steps at home to help your child feel better. By reading this you have already begun to help and support your child.

Ways to help your child with depression at home:

• Take your child's concerns seriously. Find a regular time to listen to their feelings without interruption (for example: car rides, an evening walk together, making a meal together).
  • You don't always have to agree, but it's important to acknowledge their feelings and experiences as valid for them. You can start by summarizing and reflecting back what they’ve told you. Let them know they are not alone and that you are here to support them unconditionally.
  • Keep the door open. Children and youth often pick their own times to share, so no matter how distant or irritable a child may seem, make sure they know you are ready to listen.
  • Don't give up if at first they shut you out. Your child may feel embarrassed or it may be difficult for them to share their feelings.
• Don't expect too much. Depression often affects how a child performs at school and in other activities.
• Lean on others. Make sure you have your own support system so you are able to continue supporting your child.
• Help you child with self-care. Encourage your child to make positive changes but remember depression can make it hard for your child to get going. Start small:
  • Sleep. Get enough quality sleep on a regular basis.
  • Physical activity. Help your child find an activity to enjoy such as walking, swimming, yoga or going to the gym. Support them to move their body every day if possible. You may need to do the activity with them until they start to progress and become motivated.
  • Nature. Research shows that being out in nature is an easy way to improve mood and symptoms of depression.
  • Light. Being exposed to daylight for at least 30 minutes a day can improve mood, especially during the long winter months.
  • Nutrition. Eating well can also help reduce the symptoms of depression.
• Seek professional support. Get help from a doctor or counsellor if your child is not getting better, has suicidal thoughts or appears to have a substance use problem.

Additional treatment options

The treatment team may include your child's pediatrician, family doctor, psychiatrist and a mental health professional. The treatment plan will depend upon how severe the depression is, what your child and family prefer, and what resources you are able to access. Some common treatments include psychotherapy and medication.

Psychotherapy (also called counselling or talk therapy) is often used alone if the depression is milder. It may be combined with medication for more moderate to severe depression. Psychotherapy treatment is usually 10-15 sessions and can be done one-on-one or in a group setting. There is very good evidence for the effectiveness of psychotherapy as a treatment for depression in youth. Some common types of therapy for depression include:

• Cognitive behavioural therapy (CBT)
• Interpersonal therapy (IPT)
• Family therapy

Medication (also called pharmacotherapy), specifically antidepressant medication, is often used to treat children and youth with moderate to severe depression alongside psychotherapy. Your doctor(s) will work with you and your child to pick the best medication for your child. These medications may help the child or youth start to feel better within a few weeks, but full benefits can take up to two to three months. It may take time to find the right dose or even the right medication for your child.

Talk to your doctor and get help from a mental health professional by:

• Getting a mental health assessment and support through your local Child and Youth Mental Health team (through a walk-in intake clinic in your community). 
• Contacting your Employee Assistance Plan (EAP), if you have this option through your work.
• Contacting a private psychologist or counsellor.

If your child or youth safety is at risk and immediate help is needed, call 911 or go to your local hospital’s emergency room.

If your child is thinking about ending their own life, or needs someone to talk to about suicidal thoughts or ideas:

• Call 1-800-SUICIDE (1-800-784-2433) for the BC Suicide Prevention and Intervention Line. Available in over 140 languages using a language service.
• Call 1-800-588-8717 for the BC KUU-US Indigenous Crisis and Support Line.  
• Call or text 988 for the National Suicide Crisis Helpline. Available in English and French.

Looking for more information on this topic? Connect with a family peer support worker at the Kelty Centre to discover additional resources, learn more about support and treatment options, or just to find a listening ear.