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Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings do not go away on their own. They are not necessarily related to a particular life event.

What is going on in the body?

Depression is a disorder of the brain. Researchers believe that chemicals called neurotransmitters are involved in depression. Nerve impulses cause the release of neurotransmitters from one nerve cell, or neuron, to the next. This release allows cells to communicate with one another. Too little or too much of these important neurotransmitters may be released and cause or contribute to depression. Some of the neurotransmitters believed to be linked to depression are serotonin, norepinephrine, and dopamine.

What are the signs and symptoms of the condition?

• appetite problems
• decreased energy
• difficulty paying attention or making decisions
• feeling very sensitive emotionally
• feelings of irritability
• feelings of sadness, despair, and emptiness
• inability to feel pleasure
• loss of motivation and withdrawal from others
• low self-esteem
• pessimism, negativity
• sleeping problems
• thoughts about suicide and death

• alcohol abuse
• difficulty with friendships or social outings
• drug abuse and addiction
• fear of death
• frequent vague physical ailments, such as headache
• poor school performance, tardiness, or absences
• problems with authorities
• recklessness
• sensitivity to failure or rejection

What are the causes and risks of the condition?

Many risk factors for depression have been observed through the years, though how these factors lead to imbalances of neurotransmitters in the brain remains largely a mystery.

All of the following have identified either as underlying risk factors, or as triggers for depression:

• certain illnesses
• certain medications, including antibiotics and medicines used to treat acne
• a family history of depression
• hormonal changes
• lack of sunlight
• major stresses
• negative thinking patterns

• abuse or neglect
• alcohol abuse
• chronic illness, such as diabetes
• cigarette smoking
• divorce of parents
• drug abuse and addiction
• learning disabilities
• low self-esteem
• major trauma, such as a natural disaster
• other psychiatric disorders, such as attention deficit disorder or adolescent conduct disorder

What can be done to prevent the condition?

• avoiding alcohol and illegal drugs
• avoiding cigarette smoking
• getting prompt treatment for other psychiatric disorders
• seeking effective treatment for chronic diseases
• talking with a counselor if the child experiences a major trauma

Depression can lead to suicide. It is important to recognize and treat the condition early. If a parent or other caregiver is concerned that a child may be depressed, the child should be brought to a psychologist, psychiatrist, or other licensed professional for evaluation. In addition, the child should have access to trusted family members and friends, as well as teachers and members of the clergy.

How is the condition diagnosed?

The Children's Depression Inventory, also called CDI 18, may be used to screen a child for depression. A child who screens positively should have a comprehensive evaluation for depression. The evaluation may include a history, physical examination, and laboratory tests.

What are the long-term effects of the condition?

Most children recover well from a single episode of depression. However, episodes are likely to recur. Children with depression are at risk for further episodes of depression later in life. They are also at risk for adult personality disorders. Children with depression are more likely to commit suicide than other children.

What are the risks to others?

Depression is not contagious in the true sense; however, those around a child with depression, particularly the parents, may experience additional stress and need counseling and care for themselves.

What are the treatments for the condition?

The two most common ways of treating depression in children are with antidepressant medications and psychotherapy. Often a combination is used. Occasionally a person must be hospitalized for intense treatment or for his or her own safety.

• increasing the child's ability to function in daily life
• lowering (but not eliminating) the risk of suicide
• making the child feel better

Fluoxetine (i.e., Prozac) is the only medication approved by the FDA for use to treat depression in children age 8 and older.

The other SSRI medications, such as sertraline (Zoloft), citalopram (Celexa), and paroxetine (Paxil), and the SSRI-related antidepressant venlafaxine (Effexor), have not been approved for treatment of depression in children or adolescents, though they have been prescribed to children by physicians in "off-label use"—a use other than the FDA approved use. In June 2003, the FDA recommended that paroxetine (Paxil) not be used in children and adolescents for the treatment of major depressive disorder.

The FDA has been concerned that the use of antidepressant medications in children or teens may induce suicidal behavior. Following a thorough and comprehensive review of all the available published and unpublished controlled clinical trials of antidepressants in children and adolescents, the FDA warned the public about an increased risk of suicidal thoughts or behavior ("suicidality") in children and adolescents treated with SSRI antidepressant medications.

In addition, the FDA adopted a "black box" label warning that antidepressants were found to increase the risk of suicidal thinking and behavior in children and adolescents with major depressive disorder. A black-box warning is the most serious type of warning in prescription drug labeling.

Nevertheless, studies show that there are substantial benefits from medication treatment for adolescents with moderate and severe depression, including many with suicidal ideation. So, the FDA says, "Anyone considering the use of any other antidepressant in a child or adolescent must balance this risk with the clinical need."

The FDA cautions parents that "Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber."

In August of 2004, findings from the first phase of the NIMH-funded Treatment for Adolescents with Depression Study (TADS) demonstrated a combination of medication and psychotherapy to be the most effective treatment for depression in adolescents.

• cope better with having depression
• feel less alone
• improve relations with family, friends, and coworkers
• learn about depression and how it affects them
• learn to recognize and avoid situations that can bring on a depressive episode
• learn to view the world and others more positively and more realistically
• positively address problems that they may be facing
• stop episodes of depression early by recognizing warning signs and symptoms

What are the side effects of the treatments?

• agitation
• constipation
• dizziness
• drowsiness
• dry mouth
• nausea

There is an increased risk of suicidal thoughts or behavior ("suicidality") in children and adolescents treated with SSRI antidepressant medications.

What happens after treatment for the condition?

• avoiding alcohol, illegal drugs, and smoking
• doing regular exercise
• eating a balanced diet, following the food guide pyramid
• finding a support system for dealing with depression
• finding ways to manage stress
• getting enough rest

How is the condition monitored?

Once a child has an episode of depression, he or she is at higher risk for further episodes. Any new or worsening symptoms should be reported to the healthcare provider. The provider may recommend regular visits to monitor symptoms. The provider may also order blood tests to monitor the levels of medications.