How to support a child or teenager with depression

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What are the signs of depression in children and teenagers?

One or two of the following signs of depression may be just part of growing up. However, if your child or teenager has had several of them over the past few months and it’s making they're making it hard for them to do everyday things (like study or socialise), depression is a possibility. However, it’s important to consider other causes too.

Symptoms can include:

• being irritable and snapping at others
• low, sad or depressed mood that doesn't go away
• crying easily and often
• lacking concentration and interest in school work, and may stop wanting to go to school
• feeling tired all the time
• feeling stressed or anxious
• unable to sit still, but pacing and wringing their hands
• lacking interest in usual activities 
• being forgetful
• not being able to sleep or wanting to sleep more than usual for their age
• having other sleep problems, eg, staying up late into the night and sleeping during the day, or waking often during the night
• sitting in one place for long periods, moving, responding and talking very slowly
• withdrawing from usual social contact
• being quiet and withdrawn at home
• losing their appetite or eating more resulting in weight loss or gain
• experiencing muscle tension and headaches
• experiencing unexplained physical complaints, especially stomach pains.

Depression in children and young people may look different than it does in adults

Depression in young people can present as irritability and anger. They may ask you to back off or go away. This anger can be mistaken for teenage rebelliousness or an irritable child with behaviour difficulties. 

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, they are scared they are going mad, or they think that no one will believe or support them. They may choose to tell their friends before they’re able to talk to adults. Therefore, if you notice these symptoms, ask your children about them.

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 can co-exist with depression or present in a similar way to depression. This is another reason to see a doctor as soon as possible if you have any concerns about the mental health of your child or teenager. 

What causes depression in children and teenagers?

Usually, there is no one single cause of depression in children and teenagers. Sometimes depression appears out of the blue, while at other times something seems to trigger it. Often it is a combination of factors. Your child or teenager is more likely to experience depression if they:

• experience a stressful event such as the break-up of parents, loss of a loved one or relationship break-up
• have someone in the family who has depression, such as a parent or sibling
• have experienced trauma, such as a significant injury or accident, or abuse
• are going through major life changes, such as starting a new school or going to university
• have significant physical illnesses
• have a poor daily routine or are not involved in education, training or work
• have been bullied or had other problems with peers
• are LGBTI or feel different in some other way
• use alcohol or recreational drugs.

What can parents to do help?

You can help your child or teenager by starting conversations if you notice ongoing changes in their mood. Even better, create a family culture of talking about feelings – you don’t need to wait for things to be hard to start this.

You can support their emotional wellbeing by making sure you all have a healthy lifestyle at home: having meals together, eating healthy food, having daily physical activity, limiting screen time and making sure they get plenty of sleep. A great way to do this is modelling for your children behaviours you’d like to see them taking on, eg, putting your own phone away at mealtimes, talking about how your day is going, making sure you get some exercise. 

Conflict and hostility at home are known factors that can make low mood worse in young people. On the other hand, working together with other family members supports children’s emotional wellbeing. Relationship break-downs do happen, but if you are going through a separation or divorce, do your best to ensure your child feels secure and loved, and speak respectfully about the other parent in front of them.

How is depression diagnosed?

If you’re worried your child or teenager may be depressed, see your family doctor. They will ask your child questions about their thoughts, feelings and behaviour, including sleeping and eating patterns, as well as how long they have been feeling this way. They will also ask if the young person has had any previous episodes of depression and may ask about what is happening in their life at the moment. They may also do a physical examination and blood tests to rule out other causes for their depression.

It is important to involve family members where possible when assessing and treating depression. This can become more challenging with adolescents, although remains very important. For young people under 16 years old, parents need to be involved in the consent process.

How is depression treated?

The good news is that there is a range of effective treatments for depression – it's a treatable illness. Treatment usually focuses on psychological therapies and lifestyle changes. Antidepressants are not routinely used for children and young people but may be added in some cases if depression doesn't respond to other treatments. Your GP will be able to talk through options and help work out which are best for your child or teenager. They may also refer them to a mental health specialist. Read more about mental health services for youth.

Talking therapy

The most common treatment is talking therapy. Counsellors and therapists will be supportive and understand what is happening to your child and know how to help them. They can offer help with thinking patterns and anxiety, problem-solving skills and self-esteem, as well as any other problems that might be contributing to their depression. Some of the therapy sessions may involve the child or teenager on their own and some usually involve meetings with parents and/or other family/whānau members.

Your GP will know what counselling and therapy is available in your local area. This is free for children under 14, while 14 to 25-year-olds can get free primary care services through their local Youth One Stop Shop.

If your child or teenager is at school, they can talk to a school guidance counsellor or your Hauora Youth mental health worker. Some areas in Aotearoa New Zealand have services for Māori, Pasifika and Asian youth – ask your school counsellor about these services.

Online programmes

Your doctor might recommend that your child or teenager access an online skills programme to help with treatment of depression. Some of these have been developed in collaboration with therapists and researchers and have been supported by research. However, one of the downsides to this is that it may take young people away from being able to share problems with others, which can be helpful in its own right.

Evidence-based tools developed for a New Zealand-context include:

• SPARX A free online tool to help young New Zealanders learn to deal with depression and anxiety.
• The Lowdown A website created to help young people understand and deal with depression, with chat room, personal stories, music and more.
• Aunty Dee Online problem-solving tool for young people.

Find more depression apps and e-learning.

Lifestyle changes

Improvements to key aspects of lifestyle can greatly affect mood: sleep, food, exercise and the use of alcohol or drugs. As a parent, you can help your child or teenager by supporting them to have a healthy lifestyle. Focus on their basic needs – healthy eating, physical activity and plenty of sleep. Spend time together as a family, such as daily meals and weekly outings, and limit their screen time.

Medication

Sometimes, with more severe depression, medication may be recommended. While antidepressants do not cure depression, if psychological therapy and lifestyle changes alone have not been effective, your doctor may add an antidepressant to your child or teenager's treatment plan.

Note: The use of antidepressants has been linked with suicidal thoughts and behaviour. Children, teenagers, young adults and people with a history of suicidal behaviour are particularly at risk. This is most likely during the first few weeks of starting the antidepressant or if the dose is changed. It is important to look out for signs of suicidal behaviour such as a young person talking about suicide, an increase in self-harm, worsening of low mood, agitation or aggression. If you notice any of these signs, contact your doctor as soon as possible.

Learn more

Common ground A website for parents, whānau and friends to recognise and understand the difficult situations that young people go through in their lives
Depression KidsHealth, NZ, 2016
Find out how to tell if someone is struggling with their mental health BBC, UK, 2021
Depression Black Dog Institute, Australia, 2017
Depression – youth Mental Health Foundation, NZ, 2014
depression.org.nz
Depression - for young people Women and Children's Health Network Australia
Understanding and dealing with depression – for young people Headspace Australia
Depression Headmeds UK
Kick depression Download a free e-book of scientifically proven ways to get through stuff
Mental Wealth NZ
Just a thought NZ

References

1. Facts about young New Zealanders and depression the Lowdown, NZ
2. Depression in the LGBT population Healthline, US, 2016
3. Online insomnia treatment also prevents depression Black Dog Institute, Australia, 2016
4. One hour of exercise a week can prevent depression Black Dog Institute, Australia, 2017