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Understanding depression in children
It is normal for our child to go through
phases when they feel down or behave differently. However, for some, these
phases stay around for a longer period and may adversely affect their work at
school, social interactions, and other day-to-day activities. This could be an
indication that they may be suffering from depression.
Reaching out to healthcare professionals for advice will help shed light
on whether our child is clinically depressed. Support and guidance are crucial
to help our child overcome depression. As parents, we play a key role in
supporting them in their journey towards better mental health.
Read on to find out more about depression and
how we can support our child during this difficult time.
What is depression?
Depression is a mental health condition that causes
persistent feelings of sadness and loss of interest. It can affect the way our
child eats, sleeps, feels, and thinks.
Children with depression may face difficulties in their relationships and
daily tasks, and may be unable to work towards their goals.
Common misconceptions:
Some common depressive disorders include:
Major depression
Major depression is also known as major depressive disorder, classic depression, or unipolar depression. People with major depression experience sadness to such a degree that it affects their day-to-day functioning.
Persistent depressive disorder (Dysthymia)
This is a milder form of
major depression that lasts for two
years or more.
Although
persistent
depressive disorder may not be
as intense as major depression, it can
still strain relationships and make
daily tasks difficult.
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder is a severe form of premenstrual syndrome (PMS). Sadness and other depressive symptoms arise due to hormonal fluctuations associated with the menstrual cycle. These symptoms can get in the way of day-to-day functioning.
Causes
Depression is caused by a combination of biological, psychological, and environmental factors.
Biological
Depression can run in
families, indicating hereditary or
genetic factors. Hence, some may be born
with a higher risk of developing
depression. But having a family member
with depression does not mean you will
develop the condition.
Another possible cause of
depression is a chemical imbalance in
the brain. Hormonal imbalances can also
make an individual vulnerable to
depression.
Psychological
Psychological causes may
also play a part in depression because
how a child thinks can affect how they
handle setbacks.
Children who are perfectionists,
easily affected by criticism, and prone
to anxiety may be more likely to suffer
from depression.
Environmental
Stressful or traumatic
events can cause children to suffer from
depression. This includes being bullied,
or stressful life experiences such as
the death of a loved one.
Social circumstances also play a
part. Experiencing financial difficulty
within the family, or losing friends or
family members to illness can make
children more vulnerable to depression.
Signs & symptoms
of depression
A child may experience depressive symptoms similar to what adults
may experience.
If our child experiences five or more of these common symptoms for more
than two weeks, they may have depression.
The symptoms can be described using the acronym
In SAD CAGES
Loss of
IN
terest in activities
S
leep disturbances
A
ppetite changes
D
epressed mood or feelings of sadness over a sustained period
C
oncentration difficulties
A
ctivity level changes
G
uilt or shame
Low
E
nergy
S
uicidal thoughts due to feelings of helplessness and hopelessness
Additionally, other symptoms may include:
Being easily irritable,
angry, or upset
Sharing negative comments
about themselves
These signs and symptoms can be managed with early treatment.
The following depressive disorders also
have
their individual symptoms:
Symptoms of dysthymia occur for at least two years. They include having a depressed mood and at least two of these symptoms:
Low self-esteem
Feelings of hopelessness
Poor appetite or overeating
Low energy or fatigue
Sleeping too much
or too
little
Poor concentration or
difficulty
making decisions
Symptoms of PMDD typically
appear in the week before menstruation and end a few
days after the period begins.
In PMDD, the individual has at least one symptom
from the following two categories:
Diagnosis
To diagnose depression, a healthcare professional will conduct a detailed clinical interview of our child in which they will request for:
- Past medical and psychiatry history
- Family history
- Current symptoms
- Impact on their functioning
A standardised questionnaire, physical examination, and blood tests may be administered to assess for the presence and severity of depression.
Treatment
Depression is treatable. When depression
is recognised and treated, our child’s quality of life can be greatly improved.
Treatment may consist of drug (antidepressant medication) and/or non-drug
therapy. Often, a combination of both medication and
psychotherapy is used. Patients may also be
taught effective ways to deal with life stresses.
Medication
It is natural for us to be concerned about our children taking medicines for depression. Understanding when and how medications are prescribed can help ease our concerns.
Severity of depression:
Psychotherapy
(Medication often not
needed)
- Process feelings and challenges
- Cope in more adaptive ways
- Psychotherapy
- Medication (Doctor will advise on best choice of medication e.g. antidepressants)
- Correct biochemical imbalances in the brain (usually takes 1-3 weeks for improvements to occur)
While our child is on
medication, they will be monitored very closely by
their doctor who will determine whether to adjust or
stop the antidepressant.
We should consult the doctor before
discontinuing or reducing the antidepressant as
abrupt discontinuation may cause a recurrence of
symptoms.
The doctor may
recommend that our child continues with their
antidepressant prescription for a few months even
after symptoms are gone to prevent recurrence or
relapse. For children who have had recurring
episodes of depression, a longer period of treatment
may be recommended.
It is vital to know that medication alone may
not completely cure depression. However, to aid in
recovery, it is effective in treating its symptoms
together with psychotherapy.
Non-drug therapy
Psychotherapy
Psychotherapy
Psychotherapy involves talking things through
with a healthcare professional.
Talking to someone who can listen and understand them
without passing judgement can be a relief to our child.
Additionally, our child can learn how to solve problems and
cope with life stresses better with the guidance of the
healthcare professional.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT)
CBT is a form of psychotherapy found to be effective in treating depression. It helps our child to recognise and change negative thinking and behavioural patterns.
Supporting
our child
with depression
Here are a few ways we can help our child who is going through depression:
Speak to our child about depression
Our child might not know why they are feeling so sad or
why they are not enjoying the things that they used to.
Explain to them what depression is after consulting a counsellor
or mental health professional and assure them that we will be there for
them during this difficult time.
Encourage them to seek professional support
If our child is studying in a local school, we
should reach out to their teacher to discuss our concerns. The teacher
will work closely with the school counsellor to understand their needs
and make a referral, if needed.
To help our child feel more comfortable going for treatment,
we can:
During treatment, the healthcare
professional may suggest that our child speak with them one-on-one
without a parent present. This will give them space to express concerns
they may not be comfortable expressing in our presence.
The healthcare professional's aim is not to keep things from us,
but to encourage and support our child in sharing their problems.
Be open-minded and refrain from judging
Depression can drain a person’s energy and
motivation. At times, our child might appear irritable, impatient, say
hurtful things or lash out at us in anger. As parents, we can try not to
take it to heart.
Our child may find it difficult to talk about depression, but
we can help them feel more comfortable in sharing their struggles
by:
- Acknowledging and seeking to understand what they are going through
- Making it clear that we love and support them unconditionally
- Not judging or criticising them
- Avoid telling them to “snap out of it” or “just be positive”
Be patient with them
Scolding or urging our child to stop being upset will not help. It will only shame them and make them hide their struggles from us.
Build a positive relationship with them
Having a positive relationship with us can help
make them feel that they are not alone and are being supported in this
difficult journey. We can build a positive relationship by spending
quality time and being in the moment with our child.
This means setting aside a dedicated time of the week (or day) to
spend time with them as well as showing acceptance of the struggle they
are facing and giving them our fullest attention.
Encourage them to reach out
A support system can be made for our child to reach out and talk about their emotions. This consists of trusted people who can support them in their times of need such as us, their friends, relatives, school counsellors, or teachers.
Encourage them to exercise
Regular exercise not only improves their health, but
endorphins (‘feel good’ hormones) released during exercise can improve
their mood.
If possible, exercise together with them. Play a sport like
badminton or bring them down to the park. Explore more exercise ideas
here.
Guide them through relaxation exercises
Explore ways of relaxation with them, such as:
- Deep breathing exercises where they practise the action of breathing deeply, as a method of relaxation
- Progressive muscle relaxation where they tense a group of muscles as they breathe in and relax them as they breathe out
- Guided imagery (e.g. they imagine themselves at the beach feeling the warm breeze on their skin)
Practice good sleep habits
Poor sleeping habits have been found to worsen depressive symptoms which might then worsen sleeping habits, leading to a vicious cycle. Learn how we can help our child have a good night’s sleep here.
Eat a balanced diet
A balanced diet may help improve our child’s mood. Here are some ideas that we can try for their meals.
Manage unhelpful thoughts
Sometimes, unhelpful thinking patterns may magnify
the negativity of the situation. For example, our child may
overgeneralise and think, “I have failed once, I will fail for sure
again”.
We can support them by encouraging them to share with us. This can
help them
identify
negative thoughts and assist us in understanding what they are
experiencing. We can then help them reframe such thoughts in positive
ways and focus on the good things around them.
Provide them with routines
A fixed and simple routine can help distract our child from the negative thinking patterns they might have. It can also provide a source of comfort as things are more predictable for them.
Set realistic goals
Setting and accomplishing goals can be overwhelming when
one has depression. However, by breaking down goals into manageable
pieces, they can feel more achievable.
Start planning out
goals with our child by identifying what they feel they can do and
working our way from there.
Break down tasks into smaller chunks using the SMART goal
framework: Specific, Measurable, Achievable, Realistic, Timely. Affirm
them regularly whenever they hit a goal.
Recognise achievements
Celebrate our child’s successes, however small,
while comforting and reassuring them during their struggles. While these
gains may seem insignificant, they are very big milestones for our
child.
Acknowledging these seemingly small accomplishments is
a powerful motivator and tool that encourages them to keep pressing on
and keep trying.
Actively monitor their progress
Actively monitoring our child’s progress can help them with the process of getting better. In order to do so we can:
If our child is under medication, we should remind and supervise them in taking their medication as prescribed.
Self-care matters
Taking care of our child with depression while juggling our
own life demands can take a toll on our physical and mental well-being.
Ultimately, the lack of self-care will make it more challenging for us
to care for our child.
Practising and prioritising self-care
will allow us to recharge and be in a better state to provide our child
with the support they need during their struggles with depression. Take
a look at some tips on
managing stress
and
emotions to keep
ourselves healthy.
BRAVE: Mental Health Study of Children and Adolescents in Singapore
IMH is offering free mental health and neurodevelopmental screenings for children born between 2007 and 2016 in Singapore, as part of a nationwide study. These screenings are available until the end of 2027 and include assessments for ADHD and ASD. Check if your child is eligible and express interest here.
