How Depression In Children Is Treated

What Parents Should Know About Childhood Depression

child with pills in hand

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When your child is diagnosed with depression, it can be a frightening time for the whole family. Deciding whether to start your child on medication to manage depression can be additionally confusing. However, with serious short- and long-term consequences of depression—such as poor social development, substance abuse, poor academic performance, and suicidal thoughts and behavior—it is important to find a safe and effective treatment for your child.

Knowing the risks and benefits of medications and what to watch out for can help you make a confident decision for your child.

According to the American Academy of Pediatrics (AAP), 3% of all children are diagnosed with depression. The majority of children receiving treatment experience a decrease in their symptoms within two months. It is recommended that children receive prompt treatment because of the potential for serious consequences of untreated depression.

Psychotherapy

Psychotherapy is an effective treatment for children with depression. While it’s often called "talk therapy," it involves much more than a child and psychotherapist sitting in a room talking. Common psychotherapy formats can include individual therapy, group therapy, and family therapy.

Psychotherapists also use a combination of approaches that include: 

  • Acceptance and Commitment Therapy (ACT): helps children understand ways in which they use their words to battle whatever is going on inside of their heads
  • Cognitive Behavior Therapy (CBT): teaches children to understand harmful thought patterns and feelings that influence behaviors
  • Dialectical Behavior Therapy (DBT): helps children learn to live in the moment, better cope with stress, regulate emotions, and improve relationships
  • Interpersonal Therapy (IPT): focuses on interpersonal interactions and problematic relationships and how they affect the child’s emotional state
  • Mentalization Based Therapy (MBT): focuses on the child’s ability to recognize thoughts, feelings, wishes, and desires and how they are linked to behavior
  • Parent Child Interaction Therapy (PCIT): real-time coaching sessions during which parents and children interact and therapist guides them toward positive interactions
  • Play Therapy: using toys, blocks, dolls, puppets, drawings, and games to help the child recognize, identify, and verbalize feelings
  • Psychodynamic Psychotherapy: help identify typical behavior patterns, defenses, and responses to inner conflicts and struggles
  • Supportive Therapy: offers support to manage stress, improve self-esteem, and pinpoint helpful and unhelpful behaviors

Choosing a Technique and Therapist for Your Child

The best way to find a good therapist is often via a recommendation from another parent or from your pediatrician. If you feel like things aren’t working or that your child is not clicking with the therapist, it’s well within your rights to "interview" a new therapist.

Prescriptions

The type and severity of your child's depression play a role in whether or not medication is appropriate.

For bipolar depression disorder and moderate to severe major depressive disorder (MDD), medication is typically indicated, as is recommended by the American Academy of Pediatrics. For milder cases of depression, like grief reactions due to loss or a stressful life event, counseling and family support may be sufficient.

Fluoxetine—best known as Prozac—combined with cognitive-behavioral therapy (CBT) has been shown to be an effective treatment for childhood depression. Research has found that fluoxetine combined with CBT is more effective than just medication or therapy alone. A combined treatment program may be the best treatment option for your child.

Approved Antidepressants

There are two antidepressants approved by the Food and Drug Administration to treat childhood depression. Fluoxetine (Prozac) is approved for use in children 8 years and older and escitalopram (Lexapro) is approved for use in kids older than 12.

Fluoxetine and escitalopram are selective serotonin reuptake inhibitors (SSRIs), which increase the amount of serotonin in the body. Serotonin is a neurotransmitter (a chemical affecting brain functions) that is decreased in people with depression.

Research comparing fluoxetine, sertraline, and escitalopram to placebo showed that these treatments were more effective than placebo.

Off-Label Medications

Additional medications to treat a bipolar disorder such as lithium, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) may also be prescribed. These drugs are less commonly used in children because of their potential adverse effects and limited knowledge about their effects in children. These drugs not only target serotonin, but also norepinephrine and dopamine, which are also imbalanced in depressed patients.

First-Line Treatment Recommendations

Cognitive-behavioral therapy and interpersonal therapy along with medications including fluoxetine, citalopram, and sertraline are the recommended first-line treatments for childhood depression. It is also recommended that treatment continues for a minimum of six months.

Warnings and Adverse Effects

In 2004, the FDA released a warning that SSRI use in children may put them at an increased risk for suicidal thoughts and behavior. However, the NIMH released a statement that the benefits of SSRI use in depressed children likely outweigh any risks. Additionally, the FDA explains that depression itself puts a child at an increased risk for suicidal thoughts and behavior.

SSRI medications have the potential to cause manic episodes in some children (and adults) with mood disorders, a state involving elevated, irritable or cycling moods. As such, it is important to monitor children for these symptoms.

Common adverse effects of SSRIs are headaches, nausea, sleep problems, and jitters.

Adverse effects of tricyclic drugs may be dry mouth, blurred vision, constipation, difficulty urinating, low blood pressure and heart rate changes.

Any unusual or worsening adverse effects should immediately be discussed with your child's physician. Following the prescribed treatment plan is essential. Medication should only be taken as directed and never stopped without medical advice.

How to Make Your Treatment Most Effective

It may take a few weeks of medication use there to be signs of improvement and 6 to 8 weeks for full impact. Chronic use of medication may not be necessary. Children on medication for depression should be closely monitored for improvement, adverse effects, and increased suicidal thoughts and behavior.

You can expect to take an active role in your child's medication regimen. Explaining to your child exactly what the medication is for and how it may affect him may relieve some anxiety. Developing a medication routine and incorporating something enjoyable may decrease resistance.

Communicating with your child's health care provider is also important. If appropriate, involving your child's teachers or additional caregivers can help in providing a supportive and collaborative recovery effort.

Home Remedies and Lifestyle

Support and lifestyle changes can also help children find relief from symptoms of depression. Parents can help their children by encouraging them to make healthy choices and making sure that kids are getting the proper diet, sleep, and exercise.

Healthy behaviors that can help with depression include:

Eating a healthy, nutritious diet. Diet can have an impact on physical and mental well-being, so it is important to ensure that your child is eating healthy and complete meals. Reduce or eliminate sugary snacks and drinks and focus on your child eating plenty of veggies, fruits, complex carbohydrates, and lean proteins.

Getting enough sleep. Poor sleep quality and quantity can be a symptom of depression, but it can also exacerbate symptoms. Make sure that your child has the opportunity to get a good night's rest by establishing and maintaining a consistent bedtime and creating good nighttime routines. Researchers recommend that children use their bed only for sleep, they go to bed only when tired, and get up at the same time each morning. Things that may interfere with sleep, such as a phone or TV, should be restricted or removed from the room where a child sleeps.

Regular exercise. Research has found that regular physical activity can be effective in both preventing and relieving symptoms of depression.

A 2018 study published in The American Journal of Psychiatry found that just one hour of exercise each week could be effective for preventing future depression. You can help your child by encouraging them to be more active each day.

Complementary Alternative Medicine (CAM)

While some research on adults has shown the herbal supplement St. John's wort may be effective in treating depression, there is not enough evidence supporting its use with children. The limited research available shows mixed results, with some studies finding no positive effects and others showing small benefits. 

The National Center for Complementary and Alternative Medicine states that there is not yet enough research to recommend St. John's wort as an effective treatment for childhood depression.

A Word From Verywell

Childhood depression can be a serious problem that can affect a child's ability to function in many different areas of life. Fortunately, appropriate treatment can help kids cope with their symptoms and live a normal life. The best treatment for your child depends upon their symptoms and the recommendations made by your child's pediatrician or therapist, but often a combination of psychotherapy, medication, and lifestyle changes can be an effective choice.

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