Depression - Youth

Often kids get sad, or upset or grumpy, and that is normal. This is not what we mean when we talk about depression here.

Depression is an illness that can affect how children and adolescents feel and behave for weeks or months at a time. This will affect how they function in their day-to-day lives.

Depression can range from mild to severe. It can look different in children and young people than in adults. While the familiar adult symptoms may still be there – low mood, changes in sleeping and eating, loss of energy and motivation, trouble concentrating, and so on – their most obvious symptoms may be irritability, rebellious behaviour or frequent physical pain.  

Depression can start at any age (from childhood through to old age). It is less common among younger children, with the rate increasing around mid-adolescence. Sometimes, it is the body’s way of communicating that something in the person’s life is harmful (e.g. too much school or work pressure, isolation from community, loneliness or family harm).   

Children and young people with depression often have other problems. Common co-occurring difficulties include anxiety disorders, substance use disorders, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, deliberate self-harm and suicide attempts.

The risk of suicide in people with depression is significant. It is important that if you or someone in your care is having any suicidal thoughts, you seek help immediately through a helpline or dial 111.

If you’re concerned you or your child may be depressed, a number of New Zealand websites have useful self-tests you can do, and there are sites just for children and young people. These are listed below.

Remember, depression is a serious illness, and you do need to see your doctor, a counsellor or a therapist if you suspect you, or a loved one, may be suffering from it. With the right support and treatment, it is very possible to recover from depression and live a fulfilling life.  

Symptoms of depression usually develop over days or weeks, though the child or young person may have a period of anxiety or mild depression that lasts for weeks or months beforehand. 

Depression in children and young people can look different from depression in adults. Children and young people may tend to be more irritable and rebellious than sad. Young children, especially, may not be able to express in words how they are feeling because of their age. They may be more inclined to emotional outbursts and expressions of physical illness such as frequent headaches or stomach-aches.

Signs to look for in a young person or child include:

• Irritable mood. This may be the main mood change, especially in younger children. This may show itself through aggressive and/or defiant behaviour. 
• Persistent low, sad or depressed mood. The young person may be miserable and unable to cope with daily activities. This may be expressed though negative thinking, for example, self-critical comments or complaining. 
• Loss of interest and pleasure in usual activities. This is a reduced ability for enjoyment. Children and young people may refuse to engage or appear disinterested in previously enjoyed activities. This may include loss of interest in sex in adolescents.
• Change in sleeping patterns. Most commonly, reduced sleep, with difficulty getting to sleep, disturbed sleep, and/or waking early and being unable to go back to sleep. Sometimes there can be an increase in sleep. 
• Change in appetite. Most often people do not feel like eating. Some people have increased appetite, often without pleasure in eating. This is often seen in those who also sleep more.
• Decreased energy, tiredness and fatigue. These feelings may be so severe that even the smallest task seems too difficult to finish.
• Physical slowing or agitation often comes with severe depression. The young person may sit in one place for periods and move, respond and talk very slowly; or they may be unable to sit still, but pace and wring their hands.
• Thoughts of worthlessness or guilt. As a result of feeling bad about themselves, children and young people may withdraw from doing things and from contact with others.
• Thoughts of hopelessness and death. The young person may feel there is no hope in life, wish they were dead or have thoughts of suicide.
• Difficulty in thinking clearly and concentrating. They may not be able to read a book or watch television. This can also show itself through declining performance at school. They may also have great difficulty making even simple everyday decisions.
• Loss of contact with reality. In very severe cases, depression can result in symptoms of psychosis. 

Talking therapies, adapted to the developmental level of the child or young person, are effective in the treatment of depression. A therapist can identify any underlying causes of depression, help the child or young person recognise and respond to early signs that they are entering a depressive episode, and help them learn new ways of thinking and behaving that will support their wellbeing.

Therapies identified as effective in research and treatment guidelines include: 

• Cognitive behaviour therapy (CBT) 
• Interpersonal therapy (IPT) 
• Attachment-based family therapy (as appropriate to the developmental level of the child).

Your doctor will explain what is available locally and may offer some guidance around which type of talking treatment is most suitable for your child or teenager (based on their developmental level and the severity of their depression). It’s also important to listen to the child or teenager’s own opinion and allow them to choose an option they feel drawn to. 

Although CBT is the most common style of talking therapy in these cases, it is not the only option. If your child or teenager feels it isn’t right for them, encourage them to try a new therapist or style of therapy. With perseverance, they will be able to find the right fit for them – but it can be hard to keep trying new things, especially while depressed, so your support is crucial.  

Remember, if you are experiencing depression and are at school you can talk to:

• your school guidance counsellor
• your doctor, and talk about a referral to Child and Adolescent Mental Health Services (CAMHS)
• your Hauora Youth mental health worker. Some areas in New Zealand have services for Māori, Pasifika and Asian youth – ask your school counsellor.