On the Pulse

Anxiety and Depression: The Most Common Questions Asked by Parents

4.13.2023 | Seattle Children's Press Team

A mom and daughter embrace each other while sitting on a couchAnxiety and depression are two of the most common mental health conditions seen and treated at Seattle Children’s.

Although sometimes confused, they are different classes of disorders. Some of the confusion stems from an overlap in symptoms and in fact, people often experience both at the same time.

Dr. Kalina Babeva and Dr. Sonia Venkatraman, co-directors of the Mood and Anxiety Program at Seattle Children’s, dive into these conditions with On the Pulse to answer some frequently asked questions from patients and families.

What is the difference between anxiety and depression?

Depression is a mood disorder. There are different types of depression, and the most commonly diagnosed type is Major Depressive Disorder. It is associated with sad and/or irritable mood, lack of enjoyment of previously pleasant activities and feelings of hopelessness. In its most extreme form, depression may cause suicidal thoughts or behaviors.

Anxiety is part of a separate class of disorders associated with specific fears, nervousness, worry or dread.

Both anxiety and depression can be associated with changes in sleep, appetite, difficulties with concentration, restlessness and agitation. Both types of disorders cause impairment in functioning, which means that youth have difficulty doing things they need or want to do.

Can my child have both anxiety and depression at the same time?

Yes, people can have both at the same time. Anxiety disorders tend to appear earlier than depression, with separation anxiety, specific phobias and social anxiety appearing the earliest.

How do I know if my child has depression and/or anxiety?

Symptoms of depression include persistent feelings of sadness, irritability or hopelessness and no longer enjoying things that are usually pleasurable. You may also notice other changes to your child’s behavior, such as isolating, withdrawing or having difficulty at school or in interactions with others.

In addition to worry, nervousness and dread, signs of anxiety include avoiding things or situations that cause anxiety, excessively seeking reassurance and sometimes spending more time on tasks like school assignments than would typically be needed.

When should I seek treatment for my child?

It is normal to have anxiety or depressed mood from time to time, especially when there are stressful things happening. We recommend seeking help if these feelings happen often and start interfering with your child’s daily functioning.  If they are unable to do things they normally do, or if their mood or anxiety get in the way of how they’re doing at school, at home, or in other activities or interactions, then that is a sign that they need some extra support.

If you are concerned that your child may be struggling with anxiety and/or depression, please speak with your child’s primary care doctor. Teens routinely get screened for depression and anxiety at annual well-child visits. Your child’s doctor can put in a referral for an evaluation at Seattle Children’s or elsewhere in the community.

While you wait for an evaluation, take steps to reduce the risk of suicide by removing pills (over-the-counter and prescription) and firearms from your home. If you can’t remove them, place them in a safe, lockbox or other secure place.

If you have any concerns at all about your child’s safety, or if they have made any statements about not wanting to be alive or wanting to harm themselves, talk to your child’s doctor as soon as possible; if your child is in crisis, call 988 or your local crisis line or take your child to the emergency department.

What are the common treatment options?

The most common evidence-based treatment for both anxiety and depression is called Cognitive Behavioral Therapy (CBT).  This type of therapy is short-term and skills-based. For anxiety, the most important component of CBT is exposure, or practicing facing one’s fear while resisting engaging in anxious behaviors.  For depression, the focus is often more on what we call “behavioral activation.”

A lot of kids and teens with depression tend to isolate themselves or withdraw from doing things they used to enjoy, so the goal is to help them recognize when this is happening and make a different behavioral choice. Treatment can also focus on cognitive strategies such as “reframing” negative thoughts, as well as distress tolerance strategies – building skills that help people manage distress in a healthy way.

Caregiver involvement in treatment is also common, as parents and caregivers are the most important part of a child’s life. This component of treatment focuses on helping parents and caregivers identify ways they can more effectively help their children.

Is medicine needed to help treat these disorders?

Therapy alone is often quite effective. However, if your child is really struggling such that they would not be able to fully engage in treatment, your doctor may recommend trying medicine as another part of their treatment. However, we always recommend therapy in addition to medicine.

Will my child struggle with anxiety and/or depression their whole lives?

There will always be stressful periods of time for your child, and some anxiety and low mood can be natural during those times. The goal of therapy is to help children and teens (and parents!) learn the skills to be able to deal with these stressful times, both present and future. It’s also not uncommon for youth to need to periodically learn additional skills, especially as they transition through different life stages and face different challenges.

How can I find a provider for my child?

The Washington Mental Health Referral Service for Children and Teens is a helpful resource that connects families with mental health providers in the community who accept new patients, accept insurance, and fit the child’s treatment needs. The Referral Service is free, and is for children and teens 17 and under living in Washington State. Teens between the ages of 13 and 17 can also call the Referral Service to find providers for themselves.

Another resource is our Finding Mental Health Care in Washington State Class, and you can review Choosing a Mental Health Provider to learn about the different types of providers.

What can we do while we’re waiting for treatment?

There is a lot you can do while you wait for treatment. You can learn more about mental health conditions and ways to cope through websites, books, videos and apps. You can join a support group or call a warmline. You can help your child feel heard and validated, and you can make time for self-care so that you’re best able to support your child. Explore our Mental Health Resource Hub for steps that you can take now.