Brain, Nervous System and Mental Conditions

Depression

What is depression?

It’s normal to sometimes feel sad, blue or less motivated to do the things we usually enjoy. But parents and caretakers need to act when signs of depression or anxiety begin to get in the way of a child’s or teen’s ability to successfully take part in school, family and social activities. Fortunately, there are treatments that work.

    • Look for ways to talk with your child or adolescent about reducing stress. Work together to find ways to reduce stress in the home, family and your child’s daily life. Be cautious about sharing your own stress with your child or teen.
    • Encourage and support your child in getting enough sleep. Trouble sleeping and poor sleep habits are common problems among teens and can lead to depression and anxiety or make them worse.
    • Promote healthy eating and daily exercise.
    • Pay attention to how much your child’s symptoms prevent them from taking part in daily life.
    • It’s time to take action if your child’s depression or anxiety causes them to “drop out” of their life (no longer seeing friends, leaving a team, falling grades).

    If your child’s symptoms don’t go away, get worse or make it hard for them to function, talk to your pediatrician or primary care provider and ask for a referral for a mental health evaluation. If your child refuses to go to the appointment, it’s a good idea for you or another parent or caregiver to go to the appointment to get support and learn ways to support your child.

    If your child is threatening self-harm, take them to the Emergency Department for an evaluation.

  • Depression can affect children of all ages, even preschoolers. Children and adolescents may not know how to talk about feeling down or worried and may become withdrawn or less cooperative or irritable.

    Depression becomes more common as youth move through adolescence. More than half of adolescents report feeling depressed at some point.

  • Anxiety is often part of a depressed mood. Anxiety (PDF) is feeling fearful, threatened or panicky with no clear cause.

  • There is a genetic component to depression. The condition is more common among kids with a family history of depression.

    Stress plays a key role in the start of depression. It can also cause your child’s symptoms to continue. Stress comes in all shapes and sizes and might include:

    • School pressures
    • Problems with peers
    • Family conflict
    • Pressures of adolescence (moving from elementary to middle school and middle school to high school, romantic relationships, etc.)

    The changes that take place during puberty put children at greater risk of having depression and anxiety. They are likely to react more emotionally due to their stage of brain development and the fact that they don’t yet have effective problem-solving skills.

    Some very young children seem to be at risk of depression. For these children, it is likely a combination of a genetic risk, temperament and difficulty getting involved and enjoying activities.

Depression at Seattle Children’s

Seattle Children’s Psychiatry and Behavioral Medicine providers specialize in short-term care for depression in children and teens. Our goal is to help your child get back to doing the activities that give them joy.

    • Your child is cared for by a team including mental health therapists, psychiatric nurse practitioners, psychiatrists and psychologists.
    • Our approach is to share skills and strategies that have been shown to help. We’re also doing research to develop new treatments and to find out which treatments work.
    • We’re experts in dealing with the unique challenges of depression in children and teens and in the ways it affects families. But we realize that you know your child best. We work with you and your child to develop a treatment plan that addresses your child’s individual needs.
    • We see many children and adolescents who are dealing with the stress of chronic illness, traumatic injury or serious disease. We’ll coordinate care (including medicines) with your child’s medical team.

    • Everyone on our team is specially trained to understand and meet the specific needs of children and teens. Our pediatric experts tailor care to your child’s age and developmental stage.
    • The Early Childhood Clinic sees children age 5 or younger who have behavior issues, anxiety, sleep problems, neurodevelopmental problems or prenatal (before birth) exposure to alcohol or drugs. We also see children who have other medical conditions along with a behavioral or emotional problem.
    • The Mood and Anxiety Program sees children ages 6 to 18 who have mood disorders, including depression and bipolar disorder, as well as anxiety disorders and other conditions.
    • The Psychiatry and Behavioral Medicine Unit (PBMU) treats children ages 3 to 18 who are in crisis due to complex mental health issues and need hospital-based care. The PBMU also treats people ages 19 to 21 who are developmentally delayed and in crisis.

Symptoms of Depression

Your child or teen may have some or all of these signs and symptoms of depression:

  • Sadness or feeling irritable
  • Loss of interest or pleasure in usual activities
  • Eating too much or too little
  • Weight changes
  • Sleeping too much or too little
  • Feeling tired a lot
  • Feeling guilty
  • Trouble thinking or paying attention
  • Suicidal thoughts or behavior

Other symptoms may include hopelessness, anxiety, aches and pains and oppositional behavior (being uncooperative and hostile).

  • Depression can cause:

    • School and social problems
    • An increased risk of suicide and substance use
    • Family problems
    • Repeated episodes of depression

    Due to the long-term consequences of depression, it should be taken seriously and treated.

Diagnosing Depression

As part of the diagnostic process, a mental health professional will do a short interview with you and your child. You both will also be asked to fill out a questionnaire.

Based on those tools, the mental health professional will work with you to develop a treatment plan that meets your child’s needs.

Treating Depression

Our Psychiatry and Behavioral Medicine team will work with you and your child to develop a treatment plan that responds to your child’s needs and symptoms.

All of our approaches are designed to be brief. They typically involve 3 months of weekly therapy focused on learning coping skills. The goal is to get your child back to doing the things that give them joy. Parents are actively involved in each type of treatment.

Each of the treatments we offer is supported by evidence that it is effective. Your child’s treatment may involve one or more of these approaches:

  • Behavioral activation therapy is a form of treatment for depression based on the idea that you can change how you feel by changing what you do. It is a brief intervention that focuses on increasing engagement in positive activities as a way to overcome depression.

    Two things happen when young people begin to feel depressed – life feels less rewarding and they begin to avoid the people, places and activities that typically bring them joy and a sense of accomplishment.

    The BA therapist will work with your child to help identify activities that they find rewarding. Then they will work with your child to overcome obstacles to doing the things that help them feel better. For example, the goal may be spending more time with peers. To do this, your child may need help taking small steps to gain confidence in social interactions.

  • CBT is a treatment that is based on understanding how what you think affects how you feel. The therapist will help your child learn about the relationship between thoughts, feelings and behaviors.

    CBT can help your child or teen replace negative or unhelpful thinking with helpful or coping thoughts. This can lead to changes in feelings and behavior. The therapist works together with your child to help them learn and practice new skills. This includes challenging automatic thoughts and finding new ways to think about and interpret situations. It often also involves some behavioral activation. Your child may be asked to complete homework or practice between sessions.

    CBT is used for a set length of time and is focused on meeting your child’s goals.

    Read more about CBT (PDF).

  • The focus of IPT is on understanding how a child’s or teen’s symptoms are affected by their relationships with family and peers. It is useful when depression is based on conflicts and lack of social support.

    The therapist works with your child to build interpersonal skills. This usually also involves helping your child understand automatic thoughts and generate alternatives. It may also involve elements of cognitive behavioral therapy.

  • DBT is a cognitive behavioral treatment that is used when suicidality, self-harm or other high-risk behavior is the main ongoing issue.

    DBT involves:

    • Weekly individual therapy with a Seattle Children’s DBT therapist
    • Weekly patient and multiple-family skills groups for teens and parents to learn DBT skills
    • Phone coaching between sessions to learn how to use new skills during challenging moments

    You and your teen will learn how to be more aware of emotions and patterns of behavior (mindfulness) in order to make wise, thoughtful choices. In order to build a life worth living, you and your teen will also learn how to:

    • Manage emotions
    • Cope with distress
    • Form positive relationships

    Read more about DBT (PDF) and DBT community resources (PDF).

  • Medicines can be an important part of a treatment plan. There is good evidence that antidepressants such as Prozac can be helpful for kids and teens when it is combined with another form of treatment. Medicines do have side effects, and they don’t work for everyone. Not every child needs medicine.

How to Get Services

We often have more requests from new patients than we have openings. To make an appointment, you need a referral from your child’s primary care provider. Learn more about how to get mental health services at Seattle Children’s.

If you have a referral, call 206-987-2164.

Providers, see how to refer a patient.