Depression In Children And Teens: Treatment Overview

Content provided by Healthwise

Treatment Overview

Treatment for depression in young people is similar to treatment for depression in adults and includes counseling and medicines. Although antidepressant medicines can be effective in treating depression, the safety and long-term effects of these medicines in children are not yet fully understood. But for many young people with depression, experts believe the benefits of the medicines outweigh the risks.

Less than one-third of children or teens with depression receive treatment.⁴ This may be due, in part, to the old belief that young people do not get depression or that feeling depressed is normal for their age. Also, teens often do not seek help for depression, because they may think feeling bad is normal, they may blame something else (or themselves) for their symptoms, or they may not know where to go for help. Tell your child to ask for help if he or she feels bad, and let your child know who to go to for help with depression or other problems.

Initial treatment

The type of treatment your child requires depends on whether it is his or her first episode of depression, the severity of the depression, and issues related to the cause of the depression, such as family conflict or academic problems.⁸ If your child is suicidal or is severely depressed and is out of touch with reality (psychotic) or unable to function, a stay in the hospital may be needed.

Treatment of depression in children and teens generally includes professional counseling, medicines, and education about depression for your child and your family.

Professional counseling for depression may include:

• Cognitive-behavioral therapy, which focuses on changing certain thinking and behavior patterns.
• Interpersonal therapy, which focuses on social and personal relationships and related problems.
• Problem-solving therapy, a type of cognitive therapy that helps you find practical solutions to problems.
• Family therapy, which can help educate and comfort the whole family.
• Play therapy, for very young children.

Medications used to treat childhood depression include:

• Selective serotonin reuptake inhibitors (called SSRIs), such as fluoxetine (Prozac). SSRIs are the medicines most often used for childhood or teen depression. Fluoxetine is currently the only SSRI approved by the U.S. Food and Drug Administration (FDA) for use in children, although other SSRIs are sometimes used.
• Atypical antidepressant medications, such as bupropion (for example, Wellbutrin) In some cases, these may be used to treat childhood or teen depression.
• Monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil). MAOIs are rarely given due to potentially serious side effects and dietary restrictions.
• Tricyclic antidepressants such as amitriptyline (Elavil, for example). Tricyclic antidepressants have been used in the past for childhood depression, but recent studies have found limited evidence that these medicines are effective.¹⁵ Tricyclics also carry the risk of overdose and other serious consequences, such as heart problems.

A combination of fluoxetine (Prozac, for example) and cognitive-behavioral therapy often works best.¹⁶

Should my child take medications to treat depression?

The FDA has approved the use of fluoxetine (Prozac, for example) for the treatment of depression in children and teens. But other medicines that are used to treat adult depression may also be tried to treat childhood depression, even though these medicines have not been officially approved for children by the FDA.

Before prescribing medicine to treat depression, your doctor will check your child for possible suicidal thoughts by asking a few questions. See a list of questions your doctor may ask your child.

The FDA has issued advisories stating that people who are taking antidepressants for depression, along with their family members and their health professionals, should watch for warning signs of suicide.

Education of your child and family memberscan be provided by a health professional either informally or in family therapy. Some of the most important things that your child and family members can learn include:

• Knowing how to make sure a child is following a treatment plan, such as taking medicine correctly and going to counseling appointments.
• Learning ways to reduce stress caused by living with someone who has depression.
• Knowing the signs of a relapse and what to do to prevent depression from recurring.
• Knowing the signs of suicidal behavior, how to evaluate their seriousness, and how to respond.
• Learning how to identify signs of a manic episode, which is a bout of extremely high mood and energy, or irritability that is a sign of bipolar disorder.
• Seeking treatment if you are a parent with depression.

Home treatment is an important part of treating depression. It includes:

• Getting regular exercise, such as vigorous playing, swimming, or walking, to help reduce stress.
• Eating a healthy, balanced diet.
• Getting enough sleep regularly. (Children and teenagers need more sleep than adults.)
• Avoiding the use of alcohol, tobacco, or drugs.

Ongoing treatment

Ongoing treatment depends on how severe your child's symptoms are and whether the symptoms are interfering with his or her daily activities and quality of life. Treatment includes professional counseling and may include long-term treatment with medicines.

Some children and teens do not respond to the first medicine given and may need to try several different medicines to find relief from their symptoms. Both medicines and professional counseling may be the most effective treatment, especially for children with long-term (chronic) depression that has lasted more than a year.¹⁰

An important part of ongoing treatment is making sure your child takes medicines as prescribed. Often people who feel better after taking an antidepressant for a period of time may feel like they are "cured" and no longer need treatment. But when medicine is stopped, symptoms usually return, so it is important that your child follows the treatment plan.

Your child will also need to keep counseling appointments and continue with lifestyle changes, such as eating healthy foods and getting regular exercise.

If your child has an additional illness along with depression, he or she will need to continue receiving treatment for the other illness. Tell all health professionals what medications your child is taking and the treatment he or she is receiving.

Treatment if the condition gets worse

If your child's condition gets worse during treatment for depression (which includes counseling, medications, and lifestyle changes), additional treatment may be needed. Steps include:

• Making sure your child is taking medicines as prescribed and is following other treatment recommendations, such as going to counseling appointments.
• Finding out whether ongoing symptoms are caused by another disorder (such as attention deficit hyperactivity disorder (ADHD), anxiety disorder or substance abuse) and treating the other condition if needed.
• Identifying and reducing stresses that may be making symptoms worse.
• Changing the dose or type of medicine your child is taking.
• Making sure your child continues with home treatments, such as eating a balanced diet and getting regular exercise.

A brief hospital stay may be needed, especially if your child is showing any warning signs of suicide (such as aggressive or hostile behavior, excessive thoughts about death, or detachment from reality) or is so depressed that he or she becomes out of touch with reality (psychotic) or has hallucinations or delusions. The warning signs of suicide change with age. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.

If your child is depressed, consider removing all guns and potentially fatal medicines from your home, especially if your child has shown any warning signs of suicide. Although overdosing on medicine is the most common way teens attempt suicide, your child is at higher risk for completing a suicide if you have a gun in your home, particularly if it is easily accessible or you store it loaded.¹⁰

Electroconvulsive therapy (ECT), while seldom used on children, may be helpful for those who either have not responded to other treatments or whose depression is severe. In this procedure, brief electrical stimulation to the brain is given through electrodes placed on the head. This is thought to relieve depression by altering brain chemicals known as neurotransmitters.

What To Think About

Although experts believe that, for many children with depression, the benefits of medication outweigh the risks, research on antidepressant medicine in children is limited. The long-term effects and safety of medicines used to treat depression in children and teens are still unknown. Recent U.S. Food and Drug Administration (FDA) advisories warn about the possibility of increased risk for suicide in people taking antidepressant medications.

Family involvement in the treatment for depression can be very important, especially for children and teens. Sometimes parents of children and teens with depression are also depressed and need treatment too. If a parent's depression goes untreated, it may interfere with the recovery of the child.

The sooner treatment begins for depression, the more rapidly your child is likely to recover. Waiting to seek treatment for depression may result in a longer and more difficult recovery.

Your child may start to feel better within 1 to 3 weeks of taking antidepressant medication. But it can take as many as 6 to 8 weeks to see more improvement. Make sure that your child takes antidepressants as prescribed and keeps taking them so they have time to work. During this time it can be difficult to wait to see improvement in symptoms. Your child may need to try several different medicines before finding a medicine that works.

It is common for children and teens to have another episode of depression (relapse) within 2 to 5 years of the first episode.

Last updated:	April 25, 2007
Author:	Lila Havens
Reviewed By:	Michael J. Sexton, MD - Pediatrics, Gisele Ferguson, MD, FRCPC - Psychiatry, Child and Youth Psychiatry
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC