Major Depression

Major depression, also known as clinical depression or unipolar depression, is classified as a type of affective disorder (also called mood disorder) that goes beyond the day's ordinary ups and downs.

Depression involves the body, mood and thoughts. It can affect and disrupt eating, sleeping, or thinking patterns, and is not the same as being unhappy or in a "blue" mood. It is not a sign of personal weakness or a condition that can be willed or wished away.

Children with a depressive illness cannot merely "pull themselves together" and get better. Treatment is often necessary and, many times, crucial to recovery.

The National Institute of Mental Health, part of the National Institutes of Health, reports the following:

  • Research indicates that depression onset is occurring earlier in life than it did in past decades.
  • Early-onset depression often persists, recurs and continues into adulthood. Depression in youth may also predict more severe illness in adulthood.
  • There is an increased incidence of depression in children whose parents experience depression.

The exact cause is unknown. The following are the most common risk factors for major depression:

  • Family history of mental illness, including depression and suicide (especially if a parent experienced depression as a child or teen)
  • Excessive stress
  • Abuse (physical, sexual, emotional) or neglect
  • Trauma (physical, emotional, sexual)
  • Other psychiatric disorders
  • Loss of a parent, caregiver, or other loved one, especially at an early age, to divorce, death, or abandonment
  • Brain chemistry can have an imbalance of neurotransmitters, which are naturally occurring chemicals in the brain.
  • Change in the body’s balance of hormones
  • Loss of a relationship (i.e., moving away, loss of boyfriend/girlfriend)
  • Other chronic illnesses (i.e., diabetes)
  • Other developmental, learning or conduct disorders
  • Low self-esteem, overly dependent, self- critical, pessimistic personalities   

After puberty, girls are two times as likely as boys to be at risk for major depression.

The following are the most common symptoms of major depression. However, each child or adolescent may experience symptoms differently. Symptoms may include:

  • Persistent feelings of sadness, irritability, hostility or aggression
  • Feeling hopeless or helpless, worthless or inadequate, or having low self -esteem
  • Feeling empty inside
  • Excessive guilt
  • Recurring thoughts of suicide or death
  • Loss of interest in usual activities and no longer enjoying pleasurable activities
  • Difficulty with relationships
  • Sleep disturbances (insomnia, hypersomnia)
  • Changes in appetite or weight
  • Change in activity level -- either increased or decreased energy
  • Difficulty concentrating, remembering or thinking clearly
  • A decrease in the ability to make decisions
  • Frequent physical complaints (headache, stomach ache, fatigue)
  • Running away or threats of running away from home
  • Hypersensitivity to failure or rejection
  • Anger and rage
  • Anxiety

Depression in teens may be difficult to recognize, but any of these signs may indicate problems with school, behavior, or alcohol and drug use. 

For a diagnosis of major depression to be made, a teen often needs to exhibit a "cluster" (several, generally five or more) of the above symptoms during the same two-week period. The symptoms of major depression may resemble other problems or psychiatric conditions. Symptoms must be severe enough to cause notable problems in day-to-day activities.  Always consult your teen’s doctor for a diagnosis.

Because depression often co-exists with other psychiatric disorders, such as bipolar disorder, substance abuse or anxiety disorders, seeking early evaluation, diagnosis and treatment are crucial to the recovery of your child or teen.

A child and teen psychiatrist or other mental health professional usually diagnoses major depression following a comprehensive psychiatric evaluation. An evaluation of the teen's family, in addition to information provided by teachers and care providers, may also be helpful in making a diagnosis.

Specific treatment for major depression will be determined by your child's doctor based on:

  • Your child's age, overall health and medical history
  • Extent of symptoms
  • Your child's tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Mood disorders, including major depression, can be effectively treated. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment may include one, or more, of the following:

  • Antidepressant medications:  Research shows that, when combined with psychotherapy, these drugs can be very effective in the treatment of depression in children and teens.  These medications work by rebalancing the chemicals in the brain.   Teens should be watched closely for suicidal ideation during the first few months after starting antidepressant medications. 
  • Psychotherapy:  Most often cognitive-behavioral and/or interpersonal therapy for the teen is helpful.  The focus is on changing the teen’s distorted views of themselves and the environment around them; working through difficult relationships; identifying stressors in the adolescent's environment and learning how to avoid them.
  • Family therapy
  • Consultation with the child’s school 

Parents play a vital supportive role in any treatment process. For many reasons, many parents of children with depression never seek the appropriate treatment for their child. However, approximately 80 percent of all people with major depression who do seek treatment improve, usually within weeks. Continued treatment may help to prevent reoccurrence of the depressive symptoms.

Without appropriate treatment, symptoms of depression can persist for weeks, months or years. In addition to causing interpersonal and psychosocial problems, depression in adolescents is also linked with an increased risk for suicide.  Depression often also gets worse if left untreated. 

Suicide risk rises, particularly among teen boys, when the depression is accompanied by other mental health disorders (conduct disorder, substance abuse). It is crucial for parents and care providers of teens to take all depressive and suicidal symptoms very seriously and seek treatment immediately.

Suicide is a medical emergency. Consult your child's doctor for more information.

Last Updated 06/2015