There is a difference between feeling sad and being depressed.  Sadness tends to be felt over a short period of time and is clearly related to an event. It has milder effects on day- to-day life. Grief – sadness that is experienced after a loss of a loved one – is perfectly normal and should be expected after such an event.  When these feelings don’t go away and interfere with a person’s enjoyment of life or their ability to function they may signal that it is depression. Then, it is time to see a doctor or other mental health professional.

Types of Depression

Major Depression can be a long-lasting and disabling condition that affects most aspects of a person’s life. It has distinct emotional, mental, and physical symptoms, like feeling sad, hopeless or guilty for more than two weeks, or problems with sleep and appetite.

Dysthymia is a chronic low level depression lasting for at least 2 years that reduces a person’s ability to enjoy life, or feel enthusiastic or ambitious. It often starts in childhood and can continue throughout life.

For most children and adolescents, having symptoms of depression is temporary. Having depressive symptoms early in life may signal a lifelong struggle that has major impacts on school success, future livelihood, and relationships.  Over the lifespan, depression has major repercussions and not just for the person with the condition. The children of depressed mothers have higher rates of behaviour disorders and of depression themselves. Adults with depression may go on to suffer from higher rates of chronic diseases such as heart disease, which reduce life quality or lead to early death.  Society at large experiences the loss of productivity of people with depression. So, identification and treatment of people with depression is crucial.

Cause

Symptoms of depression can be related to events in a child or teen’s life such as loss of a family member, family discord, or neglect or abuse. However, true depressive disorders tend to run in families. Current research suggests that there are processes begun in early infancy create persistently abnormal reactions to stress that contribute to the development of depression throughout life.

Treatment

Treatment of adolescents can consist of either behavioural or drug therapy. Cognitive behavioural therapy (CBT) helps change ways of thinking and acting that contribute to depressed mood. It is the treatment of choice in mild and moderate degrees of depression. In severe cases of depression, antidepressant drugs can be used. One review of the findings of multiple studies on childhood and adolescent depression drug treatment found that Fluoxetine was a safe and effective treatment for adolescent depression. A study found fluoxetine alone to be superior to CBT alone, but that the combination of fluoxetine and CBT was superior to either the drug or CBT alone in reducing depressive symptoms. The combination also produced the greatest reduction of suicidal thinking, compared to what had been present at the beginning of the study. Tricyclic antidepressants are not recommended because there are potentially deadly in overdose and because they are simply not effective.

1. Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM IV). 1994. Washington, DC: American Psychiatric Association.

Centers for Disease Control and Prevention. (1999). Suicide deaths and rates per 100,000 [On-line]. Available: http://www.cdc.gov/ncipc/ data/us9794/suic.htm
Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV).1994. Washington, DC: American Psychiatric Association.

Waddell C, McEwan K, Shepherd C, Offord DR, Hua JM. (2005). A public health strategy to improve the mental health of Canadian children. Canadian Journal of Psychiatry; 50: 226-233.

Ashman SB, Dawson G, Panagiotides H, Yamada E, Wilkinson CW. Stress hormone levels of children of depressed mothers.  Development and Psychopathology. 2002; 14: 333-349.

Whittington C, Kendall T.  Data From unpublished trials suggest that most SSRI antidepressant drugs unsuitable for children. 2004. Lancet; 363(1335): 1341-45.

March J, Silva S, Petrycki S, et al. for the Treatment for Adolescents with Depression Study (TADS) Team. 2004.  Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. JAMA;  292:807-820.

Resources

The following books and resources were developed by the Family Resource Centre at McMaster Children's Hospital based on recommendations from parents and the experiences of staff.
The selection of a book or resource is not an endorsement of all the information or suggestions contained in that resource.

Many of the resources are general in nature, and may not apply to your situation. Your health care professional is the best source of information about your child's health and concerns.

DEPRESSION
Books
Download and print
Websites
• http://www.aacap.org/publications/factsFam/depressd.htm
• http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm

ESPECIALLY FOR TEENS
Books
Download and print

GRIEF & BEREAVEMENT
Books
Download and print
Websites
• http://www.aacap.org/publications/factsFam/grief.htm
• http://www.cpa.ca/factsheets/grief.htm