Major Depression

What is major depression?

Major depression, also known as clinical depression or unipolar depression, is a mood disorder that goes beyond everyday ups and downs. It is a serious medical condition and an important health concern in the United States.

Depression can affect an adolescent's body, mood, and thoughts. It can disrupt eating, sleeping, or thinking patterns, and treatment is often necessary, and sometimes crucial, for recovery.

True depression is not the same as being unhappy or feeling blue,” nor is it a sign of personal weakness or a condition that can be willed or wished away. Adolescents with a depressive illness cannot merely pull themselves together and get better.

There are three primary types of depression:

  • Major depression (clinical depression)
  • Bipolar disorder (manic depression)
  • Dysthymic disorder (dysthymia)

Who is affected by major depression?

The National Institute of Mental Health, part of the National Institutes of Health, reports the following:

  • Research shows that depression onset is occurring earlier in life today than in the past
  • Early-onset depression often persists, recurs, and continues into adulthood
  • Depression in children or adolescents may predict more severe illness in adulthood
  • There is a higher incidence of depression in adolescents whose parents experience depression

What are the risk factors for major depression?

There are many risk factors for depression, but the most common include the following:

  • Family history of depression (especially if a parent experienced depression as a child or adolescent)
  • Excessive stress
  • Abuse or neglect
  • Trauma (physical and/or emotional
  • Other psychiatric disorders
  • Loss of a parent, caregiver, or other loved one
  • Cigarette smoking
  • Loss of a relationship (i.e., moving away, loss of boyfriend/girlfriend)
  • Other chronic illnesses (i.e., diabetes)
  • Other developmental, learning, or conduct disorders

What are the symptoms of major depression?

Every adolescent may experience symptoms differently. However, the major symptoms of major depression include:

  • Persistent feelings of sadness
  • Feeling hopeless or helpless
  • Having low self-esteem
  • Feeling inadequate
  • Excessive guilt
  • Feelings of wanting to die
  • Loss of interest in everyday or enjoyable activities
  • Difficulty with relationships
  • Sleep disturbances (i.e., insomnia, hypersomnia)
  • Changes in appetite or weight
  • Decreased energy
  • Difficulty concentrating
  • Decreased ability to make decisions
  • Suicidal thoughts or attempts
  • Frequent physical complaints (i.e., headache, stomach ache, fatigue)
  • Running away or threats of running away from home
  • Hypersensitivity to failure or rejection
  • Irritability, hostility, and aggression

A major depression diagnosis usually means an adolescent exhibits several of the symptoms during the same two-week period. Because the symptoms of major depression may resemble other problems or psychiatric conditions, a physician should always make the diagnosis.

How is major depression diagnosed?

Because depression often co-exists with other psychiatric disorders, such as substance abuse or anxiety disorders, seeking early diagnosis and treatment is crucial to the recovery of the adolescent.

A child psychiatrist or other mental health professional usually diagnoses major depression following a comprehensive psychiatric evaluation. An evaluation of the adolescent's family, when possible, in addition to information provided by teachers and care providers, may also be helpful in making a diagnosis.

What are the treatments for major depression?

Specific treatment for major depression will be determined by the adolescent's physician based on:

  • The adolescent's age, overall health, and medical history
  • Extent of the symptoms
  • The adolescent's tolerance for specific medications or therapies
  • Expectations for the course of the condition
  • Child or parent’s opinion or preference

Treatment should always be based on a comprehensive evaluation of the adolescent and family. In addition, parents always play a vital supportive role in any recovery. Treatment may include one, or more, of the following:

  • Antidepressant medications (this has shown to be very effective in the treatment of depression in children and teens, especially when combined with psychotherapy)
  • Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy). This usually focuses on:
    • Changing the adolescent's distorted views of themselves
    • Changing the adolescent’s view of their environment
    • Working through difficult relationships
    • Identifying stressors in the adolescent's environment
    • Learning how to avoid stressors
  • Family therapy
  • Consultation with the adolescent's school

Why should depression be treated?

Many parents of children or adolescents with depression never seek the appropriate treatment for their adolescent, although research has shown that many symptoms can improve quickly with the right treatment. In addition, continued treatment may help prevent reoccurrence.

Without appropriate treatment, symptoms of depression can persist for weeks, months, or years. In addition to causing interpersonal and psychosocial problems, depression in children and adolescents is also associated with an increased risk for suicide.

The Risk of Suicide

Suicide is a medical emergency that requires immediate treatment. The risk of suicide rises, particularly among adolescent boys, when the depression is accompanied by other mental health disorders or substance abuse. For this reason, all depressive and suicidal symptoms should be taken very seriously, and parents or caregivers should seek treatment immediately.

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Psychiatry and Behavioral Medicine

The Division of Psychiatry and Behavioral Medicine at Children’s National offers assessment, diagnosis, and care for children and teens with behavioral, emotional, and developmental disorders.

Psychology & Behavioral Health

Treating childhood psychological conditions requires a higher level of understanding and insight into the particular needs of young patients. Our child psychologists and other mental health professionals work exclusively with children and teens, and emphasize patient and family-focused care.

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As the largest provider of pediatric care in the Washington, DC, area and as one of the nation’s leading children’s hospitals, we treat the effects and consequences of bullying every day.

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