Depression & moodFor someone close50 min read

Depression in children and teenagers: a guide for parents

He slams doors, no longer sees his friends and sleeps until two in the afternoon on Saturdays; she has a stomach ache every morning and keeps saying she is useless. This guide helps you recognise depression behind irritability or withdrawal, ask about suicide without beating about the bush and make the home safe. It describes the treatments that have proved themselves, what is honestly known about medication in young people, and a seven-step method you can start this very week.


Dr Zayan Al-Falasi, psychiatrist

In short

This guide is for the parents of a child aged about six to twelve, or of a teenager aged twelve to seventeen, who is not doing well, whether depression has already been diagnosed or you only fear it, and for the adults who are raising this child with you. It draws on British and French guidelines and on the major studies to explain how depression shows itself at each age, how many young people it affects, what makes it more likely and what keeps it going, and what psychotherapies and medication are worth. It then sets out the safety steps to take in the face of suicide risk, a seven-step method for everyday life, a six-week plan, and pointers for seeking help at the right time and preventing relapse. Finally, it talks about what you yourself are going through, and why looking after yourself also helps your child.

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Depression & mood · Children & parents
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The programme

This guide is psychoeducational content. It does not replace a consultation. Call the emergency services in your country immediately, and stay with your child, if they have just made a suicide attempt, even one that seems minor, if they have swallowed medication or a dangerous product, if they say they are going to try to end their life, or if they have a specific plan and a means within reach. If they say they are thinking about dying but none of these situations applies, do not leave them alone, lock away the medication in the house and get advice the same day from their doctor or from your country's suicide prevention line, which you can look up right now (section 7). Unusual elation, with boundless energy and very little sleep without any tiredness, should also lead you to seek help quickly (section 13). No medication is started, changed or stopped without the doctor who prescribes it. Allow fifty minutes to read.

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1. Before you begin

It is two in the afternoon on a Saturday. Léna's door has been closed since the previous evening. When you knock to tell her lunch is ready, the answer is two words long: "Go away." Since the start of the school year, your fifteen-year-old daughter has given up handball without explanation, her marks have been slipping from one term to the next, and the slightest question ends in an argument. She still laughs on the phone with a friend now and then, and that is what makes you doubt: is it adolescence, laziness, or something else?

Or it is Noé, who is nine, and who has a stomach ache every morning before school. The doctor found nothing. He no longer touches his construction toys, cries over a broken pencil, and yesterday evening he told you, without looking up: "Anyway, I'm useless, nobody loves me."

You wonder whether you are overreacting, or whether, on the contrary, you have waited too long. You also wonder, without daring to put it into words, whether it is your fault.

Three things, straight away.

In a young person, depression often looks less like sadness than like irritability, withdrawal and a loss of desire. Medical classifications recognise this: in children and adolescents, an irritable mood can take the place of a sad mood. It is one of the reasons why so many depressions are mistaken for bad temper, rudeness or ordinary teenage turmoil.

It is not laziness, or a whim, or your fault: it is an illness, and it can be treated. In an American study that followed teenagers treated for depression over five years, almost all of them had recovered. Parents have a place in the treatments that work, and this guide tells you what that place is.

If you are wondering whether your child is thinking about dying, ask them, directly: it will not give them the idea. Studies carried out with thousands of teenagers agree on this point. And in a large American study, half of the parents whose teenager said they had already thought about killing themselves did not know: you cannot guess it, you have to ask.

2. What depression is in a young person

An illness, not a bad patch

People talk about "feeling depressed" for all sorts of things, and that is a problem. Doctors speak of a major depressive episode when several changes set in together for at least two weeks, nearly every day and for most of the day. At its centre is a mood that is sad, empty or, in young people, irritable, or else a loss of interest and pleasure in almost everything. Other signs come on top of this, affecting sleep, appetite, energy, concentration and self-image, and sometimes thoughts of death. These changes contrast with what the young person was like before, and they affect their life at school, with their friends and in the family. This summary restates in everyday language the criteria of the American Psychiatric Association's diagnostic manual, the DSM-5-TR, which doctors in many countries use.

This manual also describes a less conspicuous form, persistent depressive disorder: a low or irritable mood on most days for at least a year in children and adolescents, instead of two years in adults. It is all the more easily taken for a personality trait: "he's always been a bit gloomy".

What you may notice

Many depressed young people do not say they are sad: they are at the end of their tether, annoyed by everything, quick to explode. The Haute Autorité de santé, the public authority that issues care guidelines in France, stresses this in its 2014 guideline on depression in adolescents: irritability and agitation tend to draw annoyed or hostile reactions rather than understanding ones, and the illness then goes unnoticed. Pleasure disappears, which professionals call anhedonia: sport given up, music that no longer means anything, games abandoned by a younger child. Sleep goes awry, appetite changes, tiredness is there from the morning, and stomach aches or headaches keep coming back on school days. Thoughts grow darker: "I'm useless", "nobody loves me", "it'll never change". What counts is all these signs taken together, how long they last and how much they differ from before.

Ordinary moodiness, sorrow or depression

The French guideline sets side by side what is ordinary in adolescence and what suggests depression, and three criteria emerge from it.

Duration. Ordinary moodiness comes and goes from one day to the next. Depression settles in, nearly every day, for at least two weeks, and often for much longer by the time parents start to worry.

Pervasiveness. Ordinary sadness has an object, a bad mark or an argument, and it gives way in the face of good news. Depression spills over into everything: sleep, appetite, leisure, relationships, self-image.

Impact. The sullen teenager keeps going to lessons and seeing their friends. The depressed young person drops out: they give up their activities, withdraw, miss school, and everything costs them an effort.

The sorrow that follows a death, a break-up or a house move is not depression, even when it is intense, but depression can develop on top of it; a low opinion of themselves that takes hold should alert you. Supporting a bereaved child or adolescent helps you tell the difference after a death.

Why it gets missed

The Haute Autorité de santé describes several pitfalls: depression is confused with ordinary teenage turmoil, the signs change from one day to the next, and the mood is still able to brighten. A depressed teenager may laugh with their friends on Saturday evening and stay prostrate on Sunday, or seem exhausted in front of their homework yet find energy again for a game, which the guideline calls an appearance of "selective laziness". Teenagers are also, according to the guideline, the age group that is least likely to ask for help when things are going badly; they rarely say what they feel, but they often acknowledge it when an adult takes a genuine interest.

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What the rest contains

  • 3. A depression that looks different at each age
  • 4. How many young people are affected
  • 5. Where it comes from: what increases the risk, what protects
  • 6. What keeps depression going
  • 7. Suicide risk: knowing, asking, protecting
  • 8. The treatments that have proved themselves
  • 9. Medication: what is known in young people
  • 10. Who to turn to, and how to put it into words
  • 11. What you can do: a seven-step method
  • 12. Six weeks, step by step
  • 13. Particular situations
  • 14. Relapses: recognising them and preventing them
  • 15. Frequently asked questions
  • 16. Key points
  • 17. Sources and foundations

Frequently asked questions

How can I tell whether it is depression or ordinary teenage turmoil? Look at duration, pervasiveness and impact: depression lasts at least two weeks, nearly every day, spills over into sleep and leisure, and makes them drop out of school or pull away from their friends. If in doubt, seek advice.

They laugh with their friends in the evening. Can they still be depressed? Yes. The mood of a depressed teenager often remains able to brighten, and the French guideline names this feature among the reasons why depression goes unnoticed.

Won't asking them whether they are thinking about suicide risk giving them the idea? No. A trial carried out in American high schools, a review of published studies and the Haute Autorité de santé all conclude that asking the question gives rise neither to the thoughts nor to an attempt. Asking it shows your child that this subject can be talked about with you.

Is it our fault? No. Depression arises from several factors that combine, many of which are beyond parents' control, such as heredity or bullying. Criticism or conflict at home can weigh on it, but these can change: what you do now counts for far more than what you might have done differently.

Should we confiscate their phone? Not as the main measure: it also cuts them off from their friends and pushes them towards hidden accounts. The phone outside the bedroom at night, for the whole family, and a non-judgemental conversation about what they see online are more useful.

They refuse to see a psychologist. What can we do? Go to a consultation on your own to get advice, suggest a smaller step such as the family doctor, and let them choose whatever can be left to their choice. In immediate danger, their refusal does not stop you from calling the emergency services.

Are antidepressants dangerous for a teenager? They slightly increase the risk of suicidal thoughts and acts, although no suicide occurred in the trials, which justifies close monitoring, especially at the start of treatment. Untreated depression also carries a risk. They are kept for moderate to severe forms, together with psychotherapy, and the decision is made with the doctor.

Should they stop going to school? Rarely altogether. A temporary lighter load and a named adult help, whereas a prolonged absence makes going back more and more difficult.

I am depressed too. Does that make any difference to my child? Yes, and it is a reason to get treatment yourself: in an American study, children's disorders decreased when their mother's depression cleared up with treatment.

They are better. Can we stop the treatment? Not without talking to the professionals. Relapses are common, NICE provides for regular follow-up for a year after remission, and a medication is stopped gradually, with the doctor.

depressionchildadolescentparentsirritabilityloss of pleasuresuicide risksafety plancognitive behavioural therapyinterpersonal therapyfamily therapyantidepressantsbehavioural activationsleepphysical activityschoolscreensbullyingrelapsebipolar disorder

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