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Depression and children and adolescents.

Depression (major depressive disorder)

(Mayo Clinic Staff)


Although depression may occur only one time during your life, usually people with major depressive disorder will have multiple episodes of depression. During these episodes, symptoms occur most of the day, nearly every day and may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
  • Anxiety, agitation or restlessness
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren't your responsibility
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches

    Depression symptoms in children and teens

    Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

  • In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.

  • In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

  • Environmental factors may play a big role in depression in children.

    Children with attention-deficit/hyperactivity disorder
    (ADHD) can demonstrate irritability without sadness or loss of interest. However, major depression can occur with ADHD.

    Depression symptoms in older adults

    Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

  • Memory difficulties or personality changes
  • Physical aches or pain
  • Fatigue, loss of appetite, sleep problems, aches or loss of interest in sex — not caused by a medical condition or medication
  • Often wanting to stay at home, rather than going out to socialize or doing new things
  • Suicidal thinking or feelings, especially in older men

Behavioral Interventions to Diminish Depression
  • Diet (good nutrition is important)
  • Exercise
  • Sunlight, and being outside
  • Groom yourself in the morning
  • 10-minute tasks (break tasks up into 10 minute periods)
  • Social involvement – accept invitations to be social.
  • Decrease TV and reading the newspaper for awhile (for less things to worry about).  
  • Eliminate caffeine, and increase water intake.
  • Do anything that feels nurturing to you
  • Smile—it chemically changes your mood.
  • Use direct communication—for what you want.
  • Think or talk to yourself with love and forgiveness.
  • Serve others, or volunteer.  This releases the "feel good" chemicals and can help lift depression.

(Possible) Treatments for Depression

  • Medication
  • Therapy
  • Time
  • Spirituality and forgiveness
  • Combinations of the above
  • Major depression is the leading cause of disability in the U.S.   It can significantly interfere with individual thoughts, behaviors, moods, activities, and physical health.  
  • Depression is treatable; however, if left untreated, it can lead to suicide.  If you feel depressed, make an appointment to see your doctor as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.

    When to see a Doctor

    If you feel depressed, make an appointment to see your doctor as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.

    When to get emergency help

    If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

    Also consider these options if you're having suicidal thoughts:

    • Call your mental health specialist.

    • Call Spokane's First Call for Help at (509) 838-4428.

    • Call a suicide hotline number
      National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
      Use that same number and press "1" to reach the Veterans Crisis Line.

    • Seek help from your primary doctor or other health care provider.

    • Reach out to a close friend or loved one.

    • Contact a minister, spiritual leader, or someone else in your faith community.

      If a loved one or friend is in danger of attempting suicide or has made an attempt:
      • Make sure someone stays with that person
      • Call 911 or your local emergency number immediately
      • Or, if you can do so safely, take the person to the nearest hospital emergency room    (Source:  Depression (major depressive disorder), Mayo Clinic)
  • Depression is not a “solo” condition; it resonates throughout the entire family, and creates a significant increase in risk for depression in other family members.  When depressed mothers receive appropriate treatment, depression in their children lessens.
  • In 2013, 11% of adults reported poor mental health in Spokane County.  The proportion decreased as age and income increased, and non-whites were more likely to experience poor mental health than whites.  Poor mental health is defined as 14 or more days of poor mental health in the last 30 days.  (Spokane Counts 2015, Spokane Regional Health District)

  • Among youth ages 14-18, or 8th-12th grade, in 2014, 33% reported being depressed in the last year in Spokane County.  Depression among youth decreased as maternal education level increased, increased as age increased, and was more likely among females, Hispanics, and multi-racial youth.  (Spokane Counts 2015, Spokane Regional Health District)

  • 25 studies in the past 26 years have found that exercise can prevent depression, according to scientific research by professors from the University of Toronto.  Even moderate levels of physical activity—like walking for 20-30 minutes a day—can ward off depression in people of all ages.  (Source:  25 Studies Confirm:  Exercise prevents depression.  , by Christopher Bergland, Psychology Today, Oct. 29, 2013)
What You Can Do
  • If your depression has become unbearable, seek the advice of reputable people with certified training, professional skills, and good values.

  • If you are considering ending your life, please talk to someone.  There are people all around you who are willing to help—but you need to speak up.  Talk to someone you trust, and ask for help.

    If you have no one to talk to,
    • Call (509) 838-4428   First Call for Help in Spokane
    • Contact the Resources listed on this page. 
  • Exercise.  Get moving to help manage depression and stress.  Exercise in almost any form can act as a stress reliever. Being active can boost your feel-good endorphins and distract you from daily worries.  Most people know that exercise does your body good, but feel they are too busy and stressed to fit it into their routine. Hold on a second — there's good news when it comes to exercise and stress.

    Virtually any form of exercise,
    from aerobics to yoga, can act as a stress reliever. If you're not an athlete or even if you're out of shape, you can still make a little exercise go a long way toward stress management. Discover the connection between exercise and stress relief — and why exercise should be part of your stress management plan.

    • Exercise increases your overall health and your sense of well-being, which puts more pep in your step every day. But exercise also has some direct stress-busting benefits.

    • Exercise pumps up your endorphins. Physical activity helps bump up the production of your brain's feel-good neurotransmitters, called endorphins. Although this function is often referred to as a runner's high, a rousing game of tennis or a nature hike also can contribute to this same feeling.

    • It is meditation in motion. After a fast-paced game of racquetball or several laps in the pool, you'll often find that you've forgotten the day's irritations and concentrated only on your body's movements.

      As you begin to regularly shed your daily tensions
      through movement and physical activity, you may find that this focus on a single task, and the resulting energy and optimism, can help you remain calm and clear in everything you do.

      Exercise will improve your mood. 
      Regular exercise can increase self-confidence, it can relax you, and it can lower the symptoms associated with mild depression and anxiety. Exercise can also improve your sleep, which is often disrupted by stress, depression and anxiety. All of these exercise benefits can ease your stress levels and give you a sense of command over your body and your life.   (Mayo Clinic Staff, 2016)

  • Research on depression, anxiety and exercise shows that the physical and psychological  benefits of exercise can help improve mood and reduce anxiety.  Exercise also helps prevent and improve a number of health problems, including high blood pressure, diabetes and arthritis.  (Depression and anxiety: Exercise eases symptoms, Mayo Clinic, Sept. 27, 2017) 

  • One in 10 adults in the United States struggles with depression.  Research shows that exercise is an effective treatment. "For some people it works as well as antidepressants, although exercise alone isn't enough for someone with severe depression," says Dr. -Michael Craig Miller, assistant professor of psychiatry at Harvard Medical School.   

    The challenge of getting started.  Depression manifests physically by causing disturbed sleep, reduced energy, appetite changes, body aches, and increased pain perception, all of which can result in less motivation to exercise. It's a hard cycle to break, but Dr. Miller says getting up and moving just a little bit will help. "Start with five minutes a day of walking or any activity you enjoy. Soon, five minutes of activity will become 10, and 10 will become 15."

    You should begin to feel better
    a few weeks after you begin exercising. But this is a long-term treatment, not a onetime fix. "Pick something you can sustain over time," advises Dr. Miller. "The key is to make it something you like and something that you'll want to keep doing."  (Source:  Exercise is an all-natural treatment to fight depression,” published Aug. 2013, Harvard Health Publishing, Harvard Medical School)

  • Teen Depression and Screen Time.  Kids born between 1995 and 2012 are the first generation to spend their entire childhoods with smartphones and social media.

    "Anything that's done with a screen: texting, social media, TV, online, computer games – all of those are correlated with lower happiness….their mental health has really trended downwards starting around 2012.  Up to an hour and a half a day of screen time likely won't do harm, but that "two hours and beyond – that's when you start to see a link to these mental health issues.”

    Asked how her research has impacted her own parenting practices, Twenge said, "The day I analyzed that data looking at screen time and unhappiness and depression, I took my kids' tablets and put them in a drawer."   (Source:  “iGen” author on how digital devices are slowing the development of today’s kids, Why today’s kids are growing up less rebellious, more tolerant, less happy,’ by psychologist Jean Twenge, CBS News, August 17, 2017) 

  • Late-night screen time puts teens' sleep and mental health at risk.  Nighttime usage of a cell phone can increase anxiety and depression in teenagers and reduce self-esteem, according to a new study in the journal Child Development.  This is the first study that shows a direct link between screen time and mental health.

    Fifty percent of teens report feeling addicted to their cellphones, and the new study shows nighttime usage of a cellphone can increase anxiety and depression in teenagers and reduce self-esteem.  This is the first study that shows a direct link between screen time and mental health.  This shows us that teens using their phone late at night leads to disrupted sleep which leads to increased depression, emotional fragility and sometimes acting out.

    Cell Phones Disrupt Teen Sleep
        •    Phone time replaces sleep
        •    Screen light suppresses melatonin
        •    Content stimulates the brain
        •    Depressed teens use social media more

    Researchers note that rates of anxiety and depression in young people have risen 70% over the past couple of decades.  Psychologist Lisa Damour said that what's important about this study is that it shows a "pathway" between using cellphones at night and disrupted sleep.  "Even if they're having a great time, even if they're being super appropriate on their phone, if the phone is getting in the way of sleep they need, it still causes harm.”

    Tips for parents who want to decrease their teens' cell phone usage and how screen time affects important sleep habits: 

    1. One of the first things a parent can do is try to get ahead of the problem by instituting certain habits when kids are young.

    2. Put a power strip in your bedroom, have all the technology charged in the parents' room overnight. Make that the default family habit.

    3. Parents need to try to set the same example, by modeling good habits.  Parents have to be good about their own phones and technology and their own sleep.
The study focuses on teenage girls, who are particularly vulnerable to the effects of losing sleep. According to Damour, teen girls already got less sleep than teenage boys even before technology.

"What this new study makes us much more concerned about is:  Sleep is already fragile for teenage girls. So, we want to make sure that technology doesn't interfere with any teenager's sleep but we want to keep a special eye on the girls because we are seeing very high rates of depression,” she said. 

Although teens may be at a higher risk for negative impacts on their health, Damour admits that "Everybody needs electronic curfews and I think we can sort of just say, these are universal rules.”   (Source:  “Powering Down - New study links phone use and mental health issues in teens,” Psychologist and CBS News contributor Lisa Damour, CBS This Morning, July 3, 2017)
  • "Good deeds (helping someone in need, showing kindness, writing a thank-you note) can also serve as an effective, low-cost treatment for depression, and how we feel about ourselves, others, and life in general.

Good deeds require no doctor's prescription, have no negative side effects, and most often cost nothing more than a little time and effort and a bit of your heart. 

When you are depressed it seems difficult, and at times impossible, to think of others or do for others in any meaningful way; so, start small.  Find a way, even in your sorrow, to open your heart to others.  Write notes to people who have touched your life for good.  Make phone calls and visits to others who might be lonely.  Bake homemade treats and share them.  Miraculously, your own burdens and losses will seem more bearable, as you think and act positively for the good of others. 

Today, reflect on the good things in your life, even right them down.  As you go about your busy life, find time for service to others.  A smile, a willing heart, and a helping hand can change someone's day for the better, and yours as well."  (Music and the Spoken Word, BYU-TV, April 22, 2012)
  • Low parental parenting is associated with adolescent depression and anxiety, according to research. This indicates that parents can play a crucial role in the prevention of these disorders in their children. As a result, 171 strategies were endorsed as important or essential for preventing childhood depression or anxiety disorders by 90% of the panel; and these were written into a parenting guidelines document with 11 subheadings:

    • Establish and maintain a good relationship with your child,
    • Be involved and support increasing autonomy,
    • Encourage supportive relationships,
    • Establish family rules and consequences,
    • Encourage good health habits,
    • Minimize conflict in the home,
    • Help your child to manage emotions,
    • Help your child to set goals and solve problems,
    • Support your child when something is bothering them,
    • Help your child to manage anxiety, and
    • Encourage professional help seeking when needed.  (Source: Yap, M.B., Pilkington, P.D., Ryan, S.M., & Jorm, A.F. (2014). "Parental factors associated with depression and anxiety in young people: A systematic review and meta-analysis. Journal of Affective Disorders, 156, 8-23)

  • Remember - Abraham Lincoln, Winston Churchill, and many other people have struggled with depression.