Young girl sitting by window hugging legs

Depression

September 03, 2021

Team Mindsum

About the author: This article is written by our team of researchers and writers. Our content is published after careful review and approval by the editorial board.

What is depression?
Symptoms of depression in children and young people
Early signs of depression
Causes of depression in children and young adults?
Comorbidity with other mental health disorders
Treatment options
What types of professionals are involved?
The recovery journey
How to support someone with depression
How can parents support their child with depression?
Useful resources

What is depression?

‍Depression is when there is a change in the person’s mood, thoughts and behaviour. The changes in mood typically involve a low mood, but in children and young people, this also includes an irritable mood.

Depression can be mild, moderate or severe. A mild depression might not stop a child or young person from going about their everyday life. But a moderate or severe depression that stops a child from doing their normal activities is a cause for concern.

During severe depression, a child or young person might become overwhelmed by feelings of sadness and worthlessness. Research has shown that approximately 4% of children between the ages 5-16 in the UK are either depressed on anxious. For this reason, severe depression can make a child or young person feel suicidal. It is important to recognise these signs so that the right support can be given early on to prevent serious harm. Read more on the most commonly asked questions about depression.

Symptoms of depression in children and young people

The symptoms of depression in children are less obvious compared to adults. Children and young people show more irritability and behavioural signs of depression.

Young children may not look depressed and may not be able to explain that they feel sad. But they may show signs of irritability and can complain of headaches and abdominal pains.

Adolescents may report feeling low in mood and/or irritability. They may also blame themselves and express ideas related to self-harm or suicide.

The symptoms of depression include:

Sadness that does not go away
Being cranky or irritable
Lack of interest in things previously enjoyed
Loss of weight and/or appetite
Interacting less with friends or family
Difficulty to concentrate
Problems with sleep
Feeling tired all the time
Feelings of guilt
Feeling numb to emotions
Self-harm
Having ideas about death and suicide

“Tom’s parents recently split after many years of conflict. Since the split, Tom just doesn’t feel quite right. The things that use to get him excited, such as football, doesn’t interest him as much anymore. On most days, he has many thoughts and feelings of guilt about what happened. Sometimes these feelings are so intense that Tom can barely get out of bed. Tom’s friends know him as an active and outgoing person, but he rarely responds to their calls recently. Tom’s mother also noticed these changes in his behaviour and believe that it might be helpful for him to speak to a mental health expert.”

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Early signs of depression

It is important to understand some early signs of depression to look out for. Common signs that one may experience during the initial stages of depression include:

Feeling down, upset
Losing sense of reality
Isolating yourself from people around you and being unable to relate to other people
Low motivation
Feelings of restlessness, agitation, or irritability
Hopelessness and despairing (empty and numb)
Low self-worth, talking down on themselves
Difficulty in concentration
Resorting to substance abuse as a coping mechanism
Fatigue
Headaches or body aches
Difficulty in communication, making decisions
Loss of appetite – weight loss / Eating too much – weight gain

Causes of depression in children and young people

Early depression in children can be caused due to a variety of factors. While depression can be caused by one triggering event, it can also be caused by a mixture of factors. Each factor may not be directly attributed to depression, and they can all contribute and play a role in augmenting symptoms. Here are some factors to consider:

A history of depression in the family- Having family members who previously experienced or are experiencing depression can make it more likely for the child also to experience the same.
Conflict or violence at home- a chaotic family environment can create a stressful environment for the child and increase the risk of mood disorders.
Pressures at home or at school (e.g. having to take care of a sick relative or having many exams)
Big life changes (e.g. parent separation, death of loved one)
Trauma, physical or sexual abuse
Biochemical imbalances – imbalances in hormones can impact brain functioning
Bullying
Chronic illness (e.g. diabetes, asthma, epilepsy, irritable bowel syndrome)

Comorbidity with other mental health disorders

Individuals diagnosed with depression also tend to experience other psychological disorders.

A wide array of research has discovered that depression is comorbid with anxiety. An estimated 50-60% of individuals who have experienced depression in their lifetime have also had some experience with anxiety disorders. The feeling of restlessness, distress and changes in appetite and sleep routines are all symptoms that overlap between depression and anxiety.

Depression is also known to be linked with other mental disorders such as panic disorder, personality disorder and phobic disorder. Furthermore, it can also frequently occur with eating disorders as they are founded upon individuals leaning to extremes.

Treatment

Medication

Medication for depression can be prescribed by a doctor or psychiatrist. This is only given if the child or young person is suffering from a moderate or severe form of depression. Medication is usually taken together with talk therapy for depression.

Psychological Therapies

Cognitive Behavioural Therapy (CBT) is a type of talk therapy that focuses on how we think and act and how this affects how we feel. CBT can take anywhere between 6-20 sessions, depending on the severity of the depression and the child or young person’s age.

The idea behind CBT with children and young people is that they get to talk about their feelings and learn new skills, which they can use to fight off depressive symptoms. This all takes place in an environment of safety that the therapist is able to create for the child or young person.

The child or young person will learn how to manage the thoughts and actions that keep the depression going. With a young child, the therapist might focus on these by using stories, games, play and pictures to help the child to engage.

The therapist always finds it useful to involve other family members in the process of treatment. This is because family members also play a part in influencing the child or young person on a day-to-day basis. So, if the therapist can get the family on board, there are greater chances of success.

Interpersonal psychotherapy (IPT) is a type of talk therapy that focuses on the child or young person and their relationships, as a way to manage depression. IPT can take anywhere between 12-16 sessions depending on the severity of the depression and the child or young person’s age.

The idea behind IPT is that relationships are always involved in the course of depression. So by helping relationships to get better, depression will also get better.

The child or young person will develop an understanding of how their relationships affect the way they feel. They will learn the skills that will help their relationships to improve. These might include communication skills, conflict resolution, problem-solving and other relational skills.

During IPT, the therapist always finds it useful to involve other family members. This is because relationships with family members are the most important relationships in the life of the child or young person. Some sessions of IPT will involve other family members as well.

Supportive counselling is a type of talk therapy that focuses mainly on creating a safe space for the child or young person to talk about their difficulties. It is different from the other therapies because it doesn’t follow a set of rules. The idea behind supportive counselling is that by simply providing a safe space for the child or young person to talk about and explore their struggles with depression, they will begin to feel better.

The therapist will provide encouragement, reassurance, and advice and will mostly listen attentively. The child or young person can feel safe to let out the emotions that they may not be able to express with others. Within this safe space, the therapist will team up with the child or young person to think about helpful ways to move forward.

The therapist might also find it helpful to include other family members, especially if there is a young child involved. Other family members will also discuss ways that they can help the child to get better from depression.

What types of mental health professionals are involved?

There are different professionals that may or may not be involved throughout the treatment process of depression for children and young people. These might include counsellors, psychotherapists and doctors/psychiatrists, mental health nurses, support workers and social workers. These terms might be confusing, but the main difference is in the training that each of these professionals has received.

In the UK, there is not much of a distinction made between counsellor or psychotherapist. Both of these professionals provide therapy. However, there are some slight differences between these two professional terms. These are outlined below.

Counsellors

Counselling is focused on helping people with what they need right now. Compared to psychotherapists, counsellors tend to have shorter training and they help people deal with their issues on a more short-term basis. There may be school-based counsellors available that children and young people can approach at their own school if they feel they need support with their difficulties. Here at Mindsum, we have counsellors that are available to provide support.

Psychotherapists

Psychotherapy training tends to be longer. Psychotherapists can also give counselling but their approach to talking therapy is more in-depth, exploring the history and causes of certain behaviours and emotional issues. The psychotherapist will then treat the depression in this specialised way. Here at Mindsum, we have psychotherapists that are available to provide support.

It doesn’t mean that one professional is better than the other. All professionals in this field go through intensive training before they begin to practice. Also, many counsellors seek additional training throughout their careers.

There are also doctors and psychiatrists that can be involved in the treatment of depression for children and young people. There are more obvious differences between these two professional terms.

Doctors

These are professionals that are trained in medicine. This will likely be the family GP, who might find it necessary to prescribe certain medications that might help the depression, especially if the depression is quite severe.

Psychiatrists

These are professionals that are also trained in medicine. However, they also specialised in the field of psychiatry. So they are able to provide consultation and medication for a wide range of mental disorders such as anxiety, depression, schizophrenia, psychosis, bipolar disorder and so on.

Mental Health Nurses

Nurses trained in mental health might also be involved with the child or young person. If the child or young person is in a hospital setting or is seen by a crisis team due to self-harm or suicide, a mental health nurse might help to give treatment by administering medication.

Support Workers

‍Workers trained in helping vulnerable people to live better lives might also be involved with the child or young person. This might be within a community setting or a crisis situation. Their role is to provide emotional and practical support (e.g. helping parents to cope, helping with paperwork, and making child-care arrangements).

Social Workers

Workers trained in protecting vulnerable individuals might also be involved with the child or young person. This might also be within a community or a crisis situation. Social workers will problem-solve and organise the right support for the child or the young person to ensure their protection.

The Recovery Journey

The journey of recovery from depression can look different for each child or young person and depending on the approach that the counsellor or psychotherapist uses. But there are some things that are expected when going through therapy for depression.

Assessment

This is an important phase, where the counsellor or psychotherapist will get a feel of what is going on with the child or young person. The therapist might try to identify the severity of the depression, along with other important background information. The therapist will ask some questions, including certain questions about the possibility of self-harm or suicide. This will help to create a full picture of what is going on and to know what type of treatment will be most helpful.

Therapy sessions

These sessions will take place at a time and regularity that suits the child or young person and their parents. An important aspect of the therapy session is the relationship that the counsellor or psychotherapist will build with the child or young person. This will create a safe space that will encourage them to talk about their feelings. The child will be able to develop a better understanding of their feelings and learn helpful ways to tackle depression.

Homework

This can be an important part of treatment for depression, especially when having CBT. This is because depression affects everyday situations in the child or young person’s life. So, homework tasks will really help the child or young person to develop a sense of achievement and mastery over depression.

Progress and setbacks

When having treatment for depression, there will be progress and there may be setbacks. For example, because of the depression itself, a child or a young person might lack motivation and find it hard to believe that therapy will help. It is important not to feel discouraged when this happens, as these types of setbacks can be quite normal when dealing with depression. These situations provide opportunities to discover new ways to move forward together with the therapist.

Ending therapy

The counsellor or psychotherapist will eventually prepare the child, young person and parents for the end of therapy. This is a very important phase because it is vital for the child or young person to become confident in coping with difficult feelings without relying too much on the professional. The end of therapy will take place once the child or young person has made a lot of progress or has completely recovered from depression. The child or young person will leave therapy with many skills that they can use without the help of the therapist.

Follow up

There might be an agreement with the counsellor or psychotherapist to have a follow-up meeting. This is to check how the child or young person is coping. If they are doing well, there will be no need for more support. But if they continue to have challenges with depression or any other issues, this will be an opportunity to have extra support.

How to support someone with depression

It can be hard knowing that your loved one is suffering from depression. Especially when it is causing problems in their everyday life. Fortunately, there are some things that you can do to help. These are discussed below.

Understand depression

It is a good idea to read as much information about depression as you can. It is possible that your loved one does not even know that they are suffering from depression. Understanding depression and how it works will help you to recognise the signs that your loved one needs help.

Help them feel supported

It is common for people with depression to isolate themselves from others. Your attitude towards them can make a difference.

Show acceptance

They might be struggling with very negative thoughts about the world and themselves. For this reason, it is important to show acceptance and remind them that they are loved and valued no matter what.

Give validation

Their low mood might be something that is difficult for you to understand, but it is a real problem for them. Avoid saying things like “just snap out of it”. Acknowledge that this is a rough time for them with an attitude that is non-judgmental and non-critical.

Be persistent

Their lack of interest in doing things or staying in touch might be discouraging to you. It is good to remember that this is due to the symptoms of depression. Keep showing your support to them, even though they might seem uninterested.

Help them find the right support

Encourage them to find support through a GP or therapist. If this involves your young child, you can contact these services. You might:

Help them to search for a therapist
Help them to book an appointment with a GP or therapist
Offer support when they attend appointments (e.g. waiting in the waiting room or attending some sessions if you need to)
Help them search for support groups or self-help resources
Encourage them to keep attending sessions and to not give up
Give them small reminders to do their homework assigned by the therapist

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Know when to get urgent support

When your loved one is dealing with depression, it is good to keep an eye out for signs of self-harm or suicide. If you suspect that your loved one is at risk of hurting themselves, you should get them immediate support.

You should contact a GP or the NHS urgent helpline.

Ask them what they need

They may or may not be able to tell you what they need, but it is always good to ask. They might let you know other ways that you can help them. This way you won’t be burdened with trying to figure it out on your own.

Encourage them to do fun activities

Help them to do more uplifting activities. For example, you might put on a funny movie or take them out to their favourite activity. This will allow them to experience positive feelings that will help to fight off the depression.

Encourage them to stay active

Encourage them to stay physically active. This is very important. This might include going for walks, jogs, cycling, going to the gym or a group exercise class. Any activity that gets them moving will help their body to release ‘feel good’ chemicals in the brain that will also fight off the depression.

Know what NOT to do

When a loved one is dealing with depression, it is good to be mindful of the things we say and the way we react, as this might affect them. For example, be mindful of:

Not taking the depressive symptoms personally: When a person is depressed, their lack of interest, motivation or irritability might be misunderstood and taken personally by others. Reacting negatively might make your loved one feel guilty and even make the depression worse.
Not calling them lazy: When a person is depressed, they usually experience a lack of motivation. It is important to avoid using hurtful words such as “lazy” to describe them, during this period. It is more useful for you to find ways to help them be more active every day (e.g. inviting them out on a walk).
Don’t tell them to “just think positive”: This is not helpful for a person struggling with depression. This could also make them feel guilty for not being able to think positively. It is more useful to simply listen and try to understand the ways that depression is really a problem for them.

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Look after yourself too

It is extremely important for you to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your own well-being too.

How can parents support their child with depression

It is vital that the family and relatives of individuals diagnosed with depression, be involved in the treatment process of a child’s depression.

To begin with, the family should educate themselves about depression and make themselves aware of effective treatment methods that will work to support their child. Organise a visit to your GP to check for any health issues that could cause the depression and visit a child therapist to help them understand their depression and possibly attend talking therapy.

It’s also important for parents to learn how to interact with the child and be supportive of the child. They can do this by fostering more positive interactions and positive attitudes in the household. It’s also important to be patient and kind when your child is going through a depressive episode. Once they are calm, guide them on how to better manage their feelings and behaviours.

For urgent support

To get urgent help, you or your loved one should contact the NHS urgent helpline or the Samaritans.