Depression in childhood and adolescence

Depression is not just the "blues" or "blahs" that most of us feel from time to time. Depression is a serious problem where a low mood persists for a number of weeks, months or sometimes years at a time. There may also be a number of other signs, and these are listed below under 'Signs of depression'.

Mental health professionals used to think that young children did not experience depression. Unfortunately this is not true. Nowadays it is becoming much more common for depression to be diagnosed before children reach their teens, although adolescents are still much more likely than younger children to experience it.

Depression can be thought about as happening on a scale which ranges from severe depression and bipolar affective disorder (manic depression) which seriously affect enjoyment of daily life, through to moderate and mild depression where people have some signs of depression which make life hard to enjoy.

Bipolar disorder is marked by extreme swings of mood. Usually the person alternates between a very high or manic phase and a low or extremely depressed phase, often with normal mood levels in-between.

Although many young people who become depressed recover quickly when positive changes are made in their environment, quite a number of them can stay depressed for months, or even years. There is a form of chronic or ongoing low grade depression called dysthymia or dysthymic disorder in which the young person has a sense of gloom, does not enjoy life and has little self-esteem or confidence. They may have had these symptoms for a year or more.

There is also a form of depression known as seasonal affective disorder or SAD, a depression coinciding with seasonal changes.

Postnatal depression occurs after the birth of a baby in ten to 15 per cent of mothers. Risk factors for this include stress, poor social support and relationship difficulties - factors which may make adolescent mothers vulnerable to this form of depression

A period of depression in childhood or adolescence may cut short the development of life skills and leave long-lasting scars on a young person's beliefs about themselves and the world.

While the signs of depression are similar in adults and children, depressed children and adolescents may show more anger and irritation than adults do. They may also have more changes in mood than adults with depression, seeming quite happy one day and really down in the dumps the next.

Young people may not recognise their problem as depression, or, if they do, may feel unable to talk about it. Often the feelings that come with depression are so strong they do not tell anyone else because they feel no good or they are scared they are going mad.

With treatment, the outlook for depression is good. Most young people will have recovered from an episode of depression within a few months and almost all will recover within two years. The earlier effective treatment is started, the better and quicker their chances of recovery will be.

Signs of depression

One or two of the following signs of depression may be just part of growing up. However, if a young person has had a number of them over the last six to 12 months, it is likely they are depressed:

• irritability (snapping at others for no reason)
• crying easily and often
• lack of concentration, less interest in school work, may stop wanting to go or begin refusing to go to school
• lack of interest in usual activities, may stop going out with friends
• being forgetful
• not being able to sleep or wanting to sleep more than usual
• slow reactions and speech
• withdrawal from usual social contact, silent and withdrawn at home
• changes in eating habits resulting in weight loss or gain
• loss of appetite
• low energy levels
• muscle tension and headaches
• feeling tired all the time
• stressed or drawn facial features
• unexplained physical complaints, especially stomach pains.

How widespread is depression?

Because depression is often hidden, accurate figures of how common it is are not available.

It is generally accepted that:

• In the Western world, major depression rates are increasing and depression is occurring at an earlier age, especially among males born since the 1960s.
• New Zealand studies have found that the number of people with depression increases with age in adolescence, that it affects girls and boys equally until about age 15, after which it appears to affect more females.
• Chronic low grade depression often comes before a major depressive disorder.
• The first onset of a major depression often occurs in mid to late adolescence. Adolescents who experience depression are at risk of having a recurring episode.
• Around one in every seven people in New Zealand will develop depression in their lifetime.

Risk factors for developing depression

Factors that may contribute to depression for young people include:

• dramatic changes in mood, low self-esteem, feelings of hopelessness, being negative about life and having family or whanau problems
• depression in young people is often masked by anger and aggression, usually because they can't or they don't feel comfortable about expressing sadness and hopelessness. This may be a particular risk factor for young Maori people
• younger children may have a tendency to isolate themselves and may appear quiet and shy when they are actually depressed
• sexual, physical and emotional abuse
• bodily changes/ hormonal changes/ physical illness
• fear of growing up and independence
• changes in life situations
• difficulties with friendships, break ups, belonging, identifying with peer group, peer pressure, feeling somehow different
• dealing with sexual feelings, sexual identity, having unwanted sex
• conflict between family, cultural or religious values
• grief which is unresolved from death or other losses (eg. death of a parent before child is 18, or parents separating)
• school problems, including fear of failure
• continued put-downs or criticisms from others
• money problems, worries about getting a job
• alcohol and other drug problems
• poor nutrition or lack of exercise
• feeling spiritually lost
• family history of depression
• depression is a key risk factor for suicide in young people, especially if the young person has feelings of hopelessness.

There is a strong association between depression in young people and anxiety, conduct disorders, substance abuse, attention deficit/hyperactivity disorder (ADHD) and eating disorders. These other problems often mask the depression, as sometimes they get more attention.

Counsellors or other health professionals need, as far as possible, to eliminate sexual abuse as a contributor to depression. There is evidence which links childhood sexual abuse with depression in later life.

Myths about depression

NOT TRUE Depression is a sign of weakness.
NOT TRUE A depressed person can just 'snap out of it'.
NOT TRUE Warning signs of depression are just the normal 'moodiness' of adolescence.
NOT TRUE Every young person with depressive symptoms has a depressive disorder.
NOT TRUE Young people will grow out of depression.
NOT TRUE Young people have got nothing to be depressed about.
NOT TRUE Talking about depression (or suicide) will only make it worse.
NOT TRUE If a young person is depressed there's no way they would be suicidal.

Causes of depression

Usually there is no one single cause of depression in children and adolescents. Often it is a combination of a reaction to stress factors outside themselves and their own individual chemical 'make up'. Depression may be triggered if the stress gets too hard to bear or goes on for too long. Particular events such as childbirth or the change in seasons, especially from autumn to winter, may be the reason for depression in a number of people.

For some, the depression may be biological. The mood-switching mechanisms in their brain may be out of balance. This biological depression is usually genetic or inherited and is particularly likely if there is a clear family history of depression.

Depression can also strike after a physical illness. Sometimes alcohol or medications can change the body's chemistry and depress its systems.
 
Some types of personality may be more prone to depression than others. Shy, withdrawn teenagers may feel more isolated and alone than their more outgoing peers. They also may not be as good as others at seeking support when pressures and stresses become too hard for them to handle and may become depressed.

See also: Depression in childhood/adolescence - living with; Depression in childhood/adolescence - treatment

Support groups

See the support organisations (which include helplines) under Further information and support below.

Original material provided by the Mental Health  Foundation of New Zealand, 2002. Edited by everybody, June 2005.