Introduction

Depression is more than feeling sad or moody following a bad day. Depression can involve feelings of sadness, anger, guilt, worry or apathy. These feelings hover around like a dark cloud that won't move on. It is a parent’s job to notice when their children are struggling to cope with the challenges of being a child or teenager rather than just having a response to a bad day. When teenagers drink alcohol or take drugs to feel better, it may be a sign that they are feeling depressed.

Parents may start noticing changes in other parts of their child’s life. For example,

  • children may have usually mixed well with others, played with friends or enjoyed meeting with their peers, but now they may have lost friends and they may spend most of their time alone, withdrawn at home, and in their own rooms.
  • Activities and interests they once enjoyed may no longer be of interest to them.
  • They may have been doing well with their schoolwork but the standard of their work may have dropped because of a loss of concentration.
  • Children may not have as much energy as they used to have.
  • They may have felt good about themselves but now they dislike themselves.
  • They may take risks regularly. 

These changes can be gradual over a few weeks or even months and can indicate developing depression.

 Signs and symptoms

The most important sign of a depressive illness in children is persistent unhappiness and inability to do the normal things. Not being able to have control over feelings, not keeping up with their usual results at school and not holding onto friendships are signs of depression.

Other signs might include being more worried than usual, feeling unwell physically, crying, being irritable, feeling hopeless, feeling helpless and feeling very guilty for things that they should not feel bad about.

  • Sleep may become disturbed
    Poor sleep may include waking early in the morning, having difficulty getting to sleep or waking up repeatedly. Watching television all night, because of being unable to sleep, may result in difficulty in getting up for school or sleeping during the day.
  • Weight and appetite changes
    Weight loss of greater than 3 kilograms due to loss of appetite and interest in eating, or weight gain of greater than 3 kilograms due to eating a lot to feel better.
  • Losing normal levels of energy and the ability to enjoy life
    These are clear signs of depression. In its most extreme form, depression can cause a slowing of the way children move and think.
  • Difficulties with concentration and remembering
    These problems are often associated with being distracted and worried.
  • Bad times of the day
    When children say that they feel worse at a particular time of the day (for example, feeling worse in the morning) and the feelings are not related to a specific daily stress, then depression may be the problem.
  • Bad thoughts keep coming
    When thoughts of death, harming themselves, or harming others keep pushing themselves into children’s minds, then depression is likely.

Diagnosis

Normal feelings of being sad, "down" or "blue" usually do not last long. If children's feelings of sadness and depression continue for more than two weeks, parents should begin to be concerned.

If children think about hurting themselves or attempt to hurt themselves, parents need to make sure their child is not left alone. They need to be watched until they can be seen by a general practitioner, paediatrician or mental health professional. If children are saying they feel like hurting themselves, they will usually need help. If parents feel unable to keep them safe, they should take them to their family doctor or hospital.

Treatment

Things parents can do assist their child:

  • talk to the child’s school counsellor
  • call the local community health centre
  • talk to a general practitioner for advice about local professionals such as child psychologists or paediatricians
  • in an emergency, go to the Emergency Department at your local hospital.

 Management

Understanding emotional changes

Sometimes children and teenagers who get into trouble at home or at school may actually be depressed but not know it. Because children may not always seem sad, parents may not realise that the bad behaviour is a sign of depression. When asked directly, children can sometimes say they are unhappy or sad. But children and teenagers with depression may struggle to find the words to describe their emotions and moods. Often children won’t know they are depressed, so they don’t ask for or get the right help. Parents should try to notice changes in their children's day-to-day life and how they are coping with different feelings. When young people do not share how they are feeling, this is one sign that something is wrong.

Addressing thoughts of suicide and death

Parents often worry when a depressed child or teenager expresses feelings and thoughts that "life just isn't worth living", or that "life is so bad I feel like giving up". Hearing children say they wish they were dead can be overwhelming. Things said in an emotional moment may not mean much, but can be frightening to parents and children. If these thoughts or feelings are more than brief and temporary, they need to be taken seriously.

If children are depressed, they may be thinking about suicide. Not talking about suicidal thoughts will not make them go away. Gently, supportively and openly asking if they have thought of dying or are wishing to die is important. Asking children about these fears without panic or criticism, offers an opportunity to reduce the child’s feelings of isolation. It does not "put thoughts of suicide into their mind". If children say they want to die, it cannot be ignored. Parents may believe that children do not really mean it when they talk about suicide. However, it is important to allow children to talk about their thoughts of harming themselves. Parents should respond by taking their pain seriously.

Supporting your child

1. Be available to listen and offer help:

When children are feeling sad and down, it is important to let them know that parents will listen, spend time with them, and to find professional help for them when needed.

2. Get information:

Parents should get to know how most children grow and mature.

Parents can ask for information from health professionals and their children’s school teacher or school counsellor. For example "what's happening with my child to make them behave like this?" Parents may not be able to come up with the answers but at least they can begin to think about what they need to know.

3. Parents should ask for help from others but trust themselves to do the best for their children:

Attempting to sort out a problem within families can give children the message that parents are taking care of them. It also shows love and support for them. Sharing ideas, feelings and sorting out problems as a family will make it easier for children to talk to parents when they are feeling sad. Showing encouragement and appreciation and not criticising can also help.

4. Encourage children to:

  • talk and express their feelings
  • spend time with supportive friends
  • share feelings with others they trust
  • join in activities they enjoy
  • do exercise that is non-competitive
  • learn new ways to relax such as seeing a movie or going for a walk.

Dealing with difficult times

Parents may find it difficult living with children who are lonely, miserable, depressed or angry. During this time parents may experience many feelings, including feeling scared for their children, feeling helpless, hopeless and overwhelmed when children are hurting. Because of these feelings it will be important for parents to find ways to manage their own anger, sadness, frustration and reactions to their children.

  1. Parents can start to sort out practical problems
    Parents can offer to make an appointment to see a professional for their child and can also to be someone who can begin to help to sort things out.
  2. Parents can do special things that make themselves and their children feel good
    An example would be actively planning some future event together.
  3. Parents can put effort into feeling good
    Children need to know that parents care for them and that parents have confidence that things will get better.
  4. Parents can actively prepare for setbacks and disappointments
    Parents can accept that for things to get better, it will take time, lots of effort and energy.

Depression is usually a temporary condition in children, if recognised and helped. Even when it is a bigger problem, it will almost always respond to professional treatment. The most important part of recognising depression is to realise that depression can happen to children and to keep talking to them.

Resources and more information

Call the Transcultural Mental Health Centre for advice in your language:

  • Transcultural Mental Health Line 1800 648 911 (during business hours)
  • After hours please call NSW Mental Health Line 1800 011 511

Disclaimer

This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024