Depression

Is this your child's symptom?

• Feeling depressed or very sad
• Less joy from life. Less interest in normal activities.
• Concerns about risk for suicide are also covered.

Symptoms

People with depression have many of these symptoms:

• Feeling sad all the time
• Not able to find joy or happiness
• Loss of interest in daily activities that used to bring them pleasure
• Loss of energy (tired all the time)
• Loss of drive, doesn’t complete school work
• Feeling hopeless
• Feeling worthless or guilty
• Not able to focus or make choices
• Trouble sleeping or sleeping a lot
• Easily upset or angry
• Makes less eye contact than usual
• Talks less than usual
• Spends more time alone
• Withdrawal from social contacts
• Neglects personal grooming
• Severe depression: thoughts of death or about hurting oneself

Causes

Stresses in life can trigger a bout of depression or make it worse. Causes can include:

• Death of a loved one
• Loss of a close friend or romance
• Bullying
• Failure in a class at school
• Loss of a job
• Major life changes, such as moving to a new town or starting college
• Long term, severe illness that is not getting better
• Genetics: depression can run in some families

Suicide in the US

• Depression is a risk factor for suicide. It’s a small risk, but a real one.
• Suicide attempts, threats or plans must always be taken very seriously. Thoughts or talk about killing or hurting oneself also need evaluation on a timely basis. So do comments about "no reason to live." Emergency rooms are often your best resource.
• Suicide is the second most common cause of death in teens. Motor vehicle accidents are number one.
• About 7% of teens attempt suicide.
• Suicide deaths in the 15 to 24 age group are about 5,000 per year.
• Suicide risk starts at age 10, upon starting middle school.
• These rates have gone up during the COVID-19 pandemic.
• Depression and suicide are a mental health crisis in the US.

When to Call for Depression

Call 911 Now

• Attempted suicide today
• Acts or talks confused
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Very upset; can't be calmed down (or call 988, the Suicide and Crisis Lifeline)
• Severe depression (or call 988, the Suicide and Crisis Lifeline)
• You think your child needs to be seen, and the problem is urgent (or call 988, the Suicide and Crisis Lifeline)

Contact Doctor Within 24 Hours

• You want a referral to a mental health counselor
• Takes psych medicine and you have questions about it
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Depression keeps from going to school or other normal activities
• Self harm by cutting behavior, but denies thoughts of suicide
• Alcohol or drug use, but no symptoms now
• Grief response or mild depression lasts more than 2 weeks
• You have other questions or concerns

Self Care at Home

• Normal grief response, after recent loss of a loved one
• Mild Depression (patient continues all normal activities)
• Suicide threat hotlines and other help and support

Care Advice

Normal Grief Response

1. What You Should Know About a Grief Response
   • Sadness and depression symptoms are common and normal after the death of a loved one. It can even happen after the death of a pet.
   • The same is true after the loss of a close friend from moving or after a breakup.
   • Here is some care advice that should help.
2. Help Your Child Talk About Their Feelings
   • Encourage your child to talk about their sadness and other painful feelings. Tell them that it is normal for sadness to hit them in waves.
   • Encourage your child to cry when they feel like it. Crying helps to let go of inner pain.
   • Let your child know that the healing process takes time. It can’t be rushed.
   • Set aside time each day to find out how they are doing. Your job is to listen.
   • Look at photos together. Talk about good memories that come from the photos.
   • Ask family and close friends to reach out to your child during this hard time.
3. What to Expect:
   • The symptoms of grief should be improved by 2 weeks in children.
   • They start to eat and sleep normally.
   • They are back into normal activities.
4. Call Your Doctor If:
   • Grief response is not greatly improved by 2 weeks
   • You want your child to talk with a mental health counselor
   • You think your child needs to be seen
   • Your child becomes worse

Mild Depression

1. What You Should Know About Depression:
   • Depression is feeling sad and empty most of the time. Unlike normal times of feeling "down" or having the "blues," the sadness will not go away. The sad mood takes over how you feel.
   • Activities that used to bring you joy, no longer do.
   • Depression is a common health issue. About 1 in 10 teens come down with a bout of depression each year. Depression can also happen in younger children.
   • Your depression is caused by a recent life event. It makes sense that you are feeling sad.
   • Here is some care advice that helps people who are depressed. Share it with your child or teen. Make it happen if they can’t start on their own.
2. Talk About Your Feelings
   • Share how you are feeling with someone. Talk about your sadness, anger and other painful feelings. Nothing helps depression more than this.
   • Don’t keep painful feelings inside. Don’t let them fester. Let them go.
   • Let your family and best friends know how you are feeling. They will listen and you will be reminded how much you are loved.
   • If you can’t meet in person, phone or video chat with those who care about you.
   • If you feel like crying, do so. Crying helps to let go of inner pain.
   • When you can, try to connect with other people. It takes you out of your inner world of sadness. It will leave you feeling better.
   • Note to the parent: Hug your child or teen often. Human touch is very powerful.
3. Become More Active
   • Most depressed people tend to withdraw. That adds loneliness to your problems.
   • Do the opposite: stay active. It will make you feel better.
   • Get out of your room. Join your family for meals and entertainment.
   • School. Don’t miss any school time.
   • Sports. If you are on a team, don’t miss any practices. If you are not, join an exercise class.
   • Clubs. If you belong to a club, don’t miss any meetings. If you are not, join one.
   • Place of worship. If you belong to a church, attend regularly.
   • Get out of your home. Even going to the store will make you feel more alive.
4. Make Your Body Stronger
   • A strong body will give you confidence in what you can do. A healthy body will help you heal faster.
   • Sleep. Get enough sleep. This should be at least 8 hours per night. Sleep sharpens your thinking and lifts your mood. Depression is easier to handle if your body and mind are well rested.
   • Exercise. Exercise releases brain chemicals that will raise your spirits. At least take a walk each day. Go to a park if you have one. Being in nature is good for your mood.
   • Healthy Eating. Eat a well-balanced diet. Avoid comfort snacking. Drink lots of water. Reason: stay well hydrated.
   • Limit Your Screen Time. Social media is designed to brainwash us into wanting more. It makes it less likely that we will spend in-person talk time with our friends and family. Screen time at night also makes it hard to have healthy sleep habits.
5. What to Expect:
   • Most bouts of mild depression go away within 2 weeks. The above advice can make that more likely to happen.
   • If the depression has not lifted by 2 weeks, seek counseling. Sometimes medicines are also needed.
   • People with depression can be treated. You will get through it.
6. Depression and Suicide Resources and Helplines:
   • If your child is already in treatment, call your mental health provider.
   • For non-urgent concerns, call your local mental health resource.
   • If you don’t have their number, call National Alliance on Mental Health (NAMI).
   • The NAMI Helpline is an information and referral source for finding local mental health programs. The national toll-free phone number: 1-800-950-6264. NAMI is not a 24/7 crisis line.
   • Suicide and Crisis Lifeline: for urgent concerns about suicide or substance use crisis, call 988. This national 24/7 crisis line was established in 2022.
   • Ginger for Teens: There are newer mental health resources using podcasts and online topics. For more information, go to their website ginger.com.
7. Call Your Doctor If:
   • Your child or teen feels like hurting themself
   • Sadness or depression is not getting better after 2 weeks
   • You want your child to talk with a mental health counselor
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023

Last Revised: 03/24/2023

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.