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Patient information from the BMJ Group
Depression in children
Depression is an illness that affects people of all ages, including children and
teenagers. It can stop a child or teenager getting the most out of life. Fortunately,
there are some good treatments that can help young people get better.

We've brought together the best and most up-to-date research about depression
to see what treatments work. You can use our information to talk to your doctor
and decide which treatments are best for your child.

What happens when children get depressed?
Adults aren't the only ones who get depressed. Children and teenagers get depression,too. But depressed young people often hide their feelings. As a parent, you may find ithard to tell if your child is depressed or just going through a phase.
Depression is an illness. It can get worse if it isn't treated. But depressed children canbe helped with the right treatment. This information is about depression in children andteenagers aged 6 to 18.
No one knows for sure what causes some children and teenagers to get depression.
More girls than boys get depressed. Children may be at more risk of depression if theyfight a lot with their parents or don’t have close friends. Also, depression may run in somefamilies.
Depression in children is often triggered by events. This could be anything from the deathof a parent to the break-up of a friendship, or worries about school work.
What are the symptoms?
Children and young people often have different symptoms than adults who are depressed.
These are the symptoms you might notice if your child is depressed: Being sad or irritable most of the day, nearly every day Losing interest in the activities they used to enjoy.
Besides being in a low mood, you might notice that your child: Doesn't feel like eating or is eating more than usual Sleeps too much or too little, and has no energy BMJ Publishing Group Limited 2013. All rights reserved.
Depression in children
Blames themselves for things that go wrong. Feeling worthless or guilty for no reasonis common Can’t concentrate or make decisions. Your child's grades at school may suddenlydrop.
Younger children may have physical symptoms with no obvious cause, like headaches,stomach aches or pains in the arms or legs.
Teenagers are more likely to harm themselves. Some children cut themselves or thinkabout suicide. They may also drink alcohol or use drugs.
Children don't need to have all of these symptoms to be depressed. But if your child hasthe first two symptoms and at least two others for at least two weeks, they could havemajor depression. Don’t wait more than a couple of weeks before talking to your doctor.
What treatments work?
Most depressed young people can be helped with treatment. Talking treatments(psychotherapy) work well. Your doctor will probably suggest these first. Medicines areonly used if children have bad depression, or talking treatments alone aren’t helping.
Talking treatments
The two main talking treatments used for children with depression are interpersonal
therapy
and cognitive behaviour therapy (CBT). There haven’t been any studies
comparing the two, so we don’t know which works best. Unfortunately it can be hard to
get these treatments in some areas.
Other types of therapy are sometimes tried, but there’s not enough research to show ifthey work.
There’s good research to show that interpersonal therapy can help teenagers recoverfrom depression. In one study, three-quarters of teenagers felt less depressed, weremore sociable and better at getting along with friends after this therapy. There’s not muchresearch to show whether it works in children younger than 12 years.
In interpersonal therapy, children and teenagers work with a therapist to learn new andbetter ways of getting along with other people. It’s based on the idea that depression isoften linked to relationship problems, like fights with parents or having trouble makingfriends. Most people meet their therapist once a week for three or four months.
There’s also good research to show that cognitive behaviour therapy (CBT) helps toimprove the symptoms of depression. Having CBT in a group with other teenagers orchildren may help to get rid of depression altogether.
CBT aims to change the way you think and behave. You work with a therapist to changeunhelpful ways of thinking about yourself and the world. These ways of thinking maymake you depressed, for example if you think you are no good at anything. You learn to BMJ Publishing Group Limited 2013. All rights reserved.
Depression in children
think and behave in a more positive way. Most people meet their therapist for about 20sessions over 12 weeks.
We don’t know how long the benefits of these talking therapies last. They don’t seem tostop children and teenagers from getting depressed again in future.
Medicines
Research shows that a type of antidepressant called fluoxetine (Prozac) may help some
young people with bad depression. But it can have side effects.
Fluoxetine is one of a group of antidepressants called selective serotonin reuptakeinhibitors. It is the one that research shows works well and is safest for young people.
Doctors don’t usually give antidepressants to people under 18, and especially not childrenunder 12. But they might recommend fluoxetine if your child’s depression is very bad, ortalking treatments alone haven’t worked.
Children should only be given fluoxetine with a talking treatment. Research showsfluoxetine combined with cognitive behaviour therapy works well for teenagers withmoderate or severe depression. In studies, children took fluoxetine for at least eightweeks. It can stop depression coming back, if children keep taking it once they feel better.
There is a small risk that children taking fluoxetine might hurt themselves, or think aboutsuicide. If your child is given fluoxetine, your doctor should check regularly to make surethe depression isn’t getting worse. Research shows this is less likely to happen if theyare also having a talking treatment at the same time.
You can get withdrawal symptoms if you suddenly stop taking fluoxetine. These includefeeling dizzy or light-headed, drowsy, sick or tired, and having headaches. Children orteenagers who are taking fluoxetine shouldn't stop or reduce their dose suddenly.
Withdrawal symptoms are less likely to happen if your doctor lowers the dose gradually.
Fluoxetine can react with a type of migraine drug called a triptan (Sumatriptan is the oneused most often for children). This can be dangerous. These medicines should not betaken together.
Fluoxetine can have other side effects. Some children don’t feel like eating, and loseweight while taking it. Some children get headaches, sleep problems, shakiness andvomiting. In most cases these side effects were mild and temporary. But in one study, 4out of 48 children and teenagers stopped taking fluoxetine because they got mania (avery high mood) or a bad rash.
It’s very unusual for children to be treated with other types of antidepressant. Doctors inthe UK are advised only to use fluoxetine for children. If your doctor prescribes anothermedicine, ask him or her to explain why.
Things you can do to help your child
If you think your child may be depressed, you should talk to your child’s doctor. Here aresome other things you can do if you think your child is at risk of depression.
BMJ Publishing Group Limited 2013. All rights reserved.
Depression in children
Problems at school may have triggered your child's symptoms. For example, they maybe being bullied or having a hard time with school work. You can talk to teachers, schoolcounsellors or school psychologists to find out more. Also, consider whether problemsat home might have played a part.
Encourage your child to keep fit and healthy. Exercising three times a week for up to anhour may lift your child's mood. They may also benefit from eating the right foods, suchas plenty of fruits and vegetables.
Some people take a herbal treatment called St. John’s wort for depression. There’s someevidence that it might work for adults. But there’s no research to show whether it is safeor helpful for children with depression. It can also interfere with the way some othermedicines work. It should not be taken with migraine medicines called triptans or withantidepressants.
What will happen to my child?
Depression can badly affect your child's development, both in their social life and in theirschool life. A bout of depression lasts on average seven months. Some children recoverfrom depression without treatment, but at least one half of children who don’t havetreatment will still be depressed after a year. That’s why it’s important to get help. Theright treatment reduces a child’s risk of having depression lasting a year or more.
Children who have had a bout of depression may get another one in future, either as achild or teenager, or when they are older. Knowing which treatments help can be veryuseful to help manage these relapses.
It’s important to know that as many as a third of depressed teenagers and children trysuicide. Any parent will find this very painful to consider. But being alert, and knowinghow to get emergency medical help for your child, may help prevent this happening.
If children say they are thinking about suicide, it's a clear sign that they need help. Youneed to take this very seriously. Call your doctor straight away. You can also make anemergency plan with your doctor, to use if you become worried that your child is suicidal.
Where to get more help
Young Minds is a UK charity for children and young people with mental health problems,and their parents. You can contact the helpline on 0800 018 2138 or visit the website(http://www.youngminds.org.uk).
This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. for this content.
For more information about this condition and sources of the information contained in this leaflet please visit the BestHealth websiteThese leaflets are reviewed annually.
BMJ Publishing Group Limited 2013. All rights reserved.
Last published: Mar 13, 2013

Source: http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/532075.pdf

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