Depression is a serious mood disorder that can take the joy from your child's life. It may occur when brain chemicals that affect your child's mood get out of balance. Stress, family problems, or trauma such as violence, abuse, or neglect can cause this to happen.

Depression runs in families. Children and teens who have a parent with depression are more likely to have depression than children whose parents are not depressed. As many as 2 out of 100 children and 8 out of 100 teens have serious depression.^{footnote 1}

It may be hard to know if your child is depressed or just moody. It's normal for a child to be moody or sad from time to time. It's often just a part of growing up. You can expect these feelings after the death of a loved one or pet, a move to a new city, or a divorce.

But if these feelings last for weeks or months, they may be a sign of depression.

If your child is just moody, he or she probably doesn't need treatment. But if your child is depressed, he or she may need medicine, counselling, or both to feel better.

It may also be hard to know if your child's symptoms are caused by something other than depression. Some medical problems can cause symptoms that look like depression. Your child's doctor may do some tests to help rule out physical problems, such as a low thyroid level or anemia, and other problems such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder.

If your child is depressed, he or she is more likely to:^{footnote 2}

• Do poorly in school or at work.
• Have relationship problems with friends and family members.
• Get pregnant.
• Get sick.
• Smoke.
• Use alcohol or drugs.
• Try or die by suicide. If your child has severe depression, he or she is at a greater risk for suicide or attempted suicide. Some warning signs of suicide might include problems with substance use or thoughts about death. Suicide attempts in children younger than age 12 are rare.

Medicines called antidepressants are used to treat depression in children and teens. In general, antidepressants increase the level of certain chemicals in the brain. These chemicals are called neurotransmitters. This helps improve communication between brain cells over time, which can help your child feel better.

There are several types of antidepressant medicines. Fluoxetine (Prozac) is usually the first type of antidepressant given. Another SSRI, such as citalopram (Celexa) or sertraline (Zoloft), may be tried if fluoxetine doesn't help your child feel better.

Other medicines may also be used. But the possible side effects of these medicines are more serious than those of SSRIs. These other medicines include:

• Atypical antidepressants, including bupropion (such as Wellbutrin).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), including venlafaxine (such as Effexor).

Your child will take pills or liquid medicine every day for as long as he or she needs them. Your child may start to feel better within 1 to 3 weeks after starting an SSRI. But it can take as many as 6 to 8 weeks to see more improvement. It's important that your child takes the medicine as prescribed and keeps taking it so it has time to work.

If you have questions or concerns about your child's medicine, or if you don't notice any improvement by 3 weeks, talk to your doctor. Your child may need to try several different medicines to find one that works.

Your child's medicine may cause side effects, but they will usually go away within the first few weeks. Common side effects include:

• Nausea.
• Loss of appetite.
• Diarrhea.
• Headaches.
• Sleep problems or drowsiness.
• Feeling anxious or grouchy.
• Feeling dizzy or shaky (tremor).

There is also a small chance that your child might think about suicide while taking antidepressants, especially during the first few weeks of treatment.

A combination of fluoxetine and individual counselling often works better than if only one kind of treatment is used. This is especially true if your child's symptoms are severe. One study showed that after 12 weeks of treatment:^{footnote 3, footnote 4}

• Out of 100 children who used medicine and counselling, 71 were helped, and 29 were not.
• Out of 100 children who used only medicine, 60 were helped, and 40 were not.
• Out of 100 children who used only counselling, 43 were helped, and 57 were not.

This same study continued to follow these children. At 36 weeks:

• Out of 100 children who used medicine and counselling, 86 were helped, and 14 were not.
• Out of 100 children who used only medicine, 81 were helped, and 19 were not.
• Out of 100 children who used only counselling, 81 were helped, and 19 were not.

Over time, the children were helped equally by the three different treatments. But using both medicine and counselling reduced depression symptoms faster than either medicine or counselling alone.

Some children who are first diagnosed with depression are later diagnosed with bipolar disorder, which has symptoms that cycle between depression and mania. If your child or teen has bipolar disorder, a first episode of mania can happen spontaneously. But it can also be triggered by antidepressants. That is why it is very important to tell your child's doctor about any family history of bipolar disorder and to watch your child closely for signs of manic behaviour.

Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) has issued advisories on antidepressant medicines and the risk of suicide. Health Canada and the FDA do not recommend that people stop using these medicines. Instead, people taking antidepressants should be watched for warning signs of suicide, such as saying they are going to hurt themselves, talking or writing about death, or giving away their things. This is especially important at the beginning of treatment or when doses are changed.

Studies by the FDA have found that:

• About 4 out of 100 children who used an antidepressant had suicidal thoughts or behaviour. This means that 96 out of 100 children who used antidepressants did not have suicidal thoughts or behaviour.^{footnote 5}
• The benefit of taking antidepressants was greater than the risk of suicide in children and teens. For some young people, taking an antidepressant can help ease the symptoms of depression and may actually reduce the risk of suicide in the long run.^{footnote 6}

If your child's symptoms are mild to moderate, counselling or lifestyle changes may be enough to help your child feel better.

There are different types of counselling that may help your child.

• Cognitive behavioural therapy can help your child understand why he or she feels a certain way. And it can help your child cope with problems by changing the way he or she thinks and behaves.
• Interpersonal therapy can help your child build relationships with others.
• Problem-solving therapy can help your child find positive ways to deal with problems.
• Family therapy provides a place for your child and the entire family to express fears and concerns and learn new ways of getting along.
• Play therapy engages children in activities that can help them cope with their problems and fears.

Here are some things that you can do at home to help your child feel better:

• Encourage your child to exercise, eat healthy foods, and get enough sleep.
• Encourage your child to socialize with supportive friends.
• Make time to talk and listen to your child and express your love and support.
• Remind your child that things will get better in time.

Your doctor may advise that your child take medicine for depression if:

• Your child's symptoms are severe.
• Your child isn't feeling better with counselling alone.