BRJKP6 Teenage Girl Looking Upset

Ask a UCSF Benioff Children’s Hospital Expert

by Petra Steinbuchel, MD, Director of Child & Adolescent Psychiatry

Q: Do children and teens suffer from depression?
A: Sadness, grief, anxiety, and anger are all part of our normal range of human emotions. It is only when sadness becomes so pervasive that it interferes with our regular daily functioning that we consider it depression. Depression can and does occur in childhood (up to 5 percent before puberty), with rates increasing during adolescence (5 to 20 percent by age 18). Left untreated, depression can derail a young person from achieving important and time-sensitive academic, social, and emotional milestones, and it may leave a youth vulnerable to substance abuse. The longer depression remains untreated, the more likely a young person is to have chronic or recurrent depression throughout adulthood

Q: How do you recognize when your child or teen is suffering from depression?
A: Depression is defined as two or more weeks of constantly sad or irritable mood, loss of interest and inability to experience pleasure in things that used to be fun, feelings of guilt or worthlessness, and hopelessness or helplessness. It’s characterized by low energy, physical restlessness or slowing, and changes in sleep and appetite can occur as well. Anxiety can often accompany depression, as can poor concentration, together with decline in academic performance.

Q: What are the reasons behind depression in young people?
A: Teenagers become more susceptible to depression during adolescence due to hormonal changes, significant brain development, changing sleep patterns, greater likelihood of substance use—in particular, alcohol and marijuana, increased social and academic pressures, and seeking to understand and form their own identity.

The incidence of depression is equal in boys and girls before puberty, but it doubles in girls after puberty. The reasons for this change are not clear, but hormonal changes and/or broader social acceptance of girls’ expressing their feelings (and thus perhaps underdiagnosis in boys) may be contributing factors.

Q: What are the consequences of depression in children and teenagers?
A: The most concerning aspect of depression is when hopelessness or helplessness leads to suicidal thinking and/or behavior. Suicidality ranges on a continuum from vague, infrequent feelings that life is not worth living to much more serious and sustained plans of actually committing suicide, with the intention to carry out these plans. Some youth also engage in self-injurious behavior, most commonly cutting. While cutting can be an additional risk factor for suicide, cutting is often different than an actual suicide attempt. Instead, it can be a physical way of either releasing emotional pain or inflicting physical pain to distract from intense emotions such as sadness or anger.

Q: What can parents do to help their children?
A: If you are concerned about your child’s mood, try to ask in a warm, casual, and open way about how they are doing. Hopefully this is in the context of a mutually respectful and trusting relationship you already have with your child. If you think your child may be depressed, consult your pediatrician to have an initial assessment done and to screen for certain medical conditions that may mimic depression, including anemia, thyroid disease, vitamin deficiencies, infections, or other disorders. Mild to moderate depression often improves with education to teens and their families about feelings and what they can do to feel better.

Q: When is therapy or medication appropriate?
A: Psychotherapy can be helpful for working through stressful life events, relationships, or past trauma; teaching coping techniques; and understanding the links among thoughts, mood, and behavior. If depression is moderate to severe, sometimes medication can be prescribed. Antidepressant medications are not addictive, nor do they change a person’s personality or make someone “happy all the time.” However, they can be a helpful adjunct to psychotherapy and other lifestyle changes, including diet, exercise, and strengthened family, social, and/or spiritual support. A trusted medical provider can provide guidance regarding the benefits and risks of starting an antidepressant and deciding together when to appropriately discontinue.