Depression is when your child's mood is very low, with no obvious cause.
The symptoms of depression in childhood are very similar to those of depression in adults.
- depressed mood most of the day, every day
- loss of interest or pleasure in activities
- significant weight loss, when not dieting, or weight gain
- a decrease or increase in appetite
- frequent insomnia or sleeping too much
- extreme restlessness or lethargy
- fatigue or loss of energy
- feelings of worthlessness or inappropriate guilt
- diminished ability to think or concentrate
- recurrent thoughts of death and suicidal thoughts.
Children are likely to seem more irritable than sad, and they are more likely to have insomnia than sleep too much.
You may notice your child:
- doesn't want to do the things they usually enjoy
- avoids people
- complain they can't sleep well
- has a change in their eating patterns.
They might start being critical about themselves or say they feel useless. They won't do as well as usual at school, because they can't concentrate and don't have the energy to finish off work.
Some of the symptoms of depression – particularly restlessness and finding it difficult to concentrate – overlap with ADHD, so it makes it harder to see if a child with ADHD has depression.
It's also more likely to be missed in boys because the symptoms of ADHD are more obvious than the symptoms of depression. Boys are also more likely to:
- get into fights
- cut themselves
- steer clear of friends.
It's worth talking to your GP about the possibility of depression if you notice:
- your child has stopped doing the things they usually enjoy
- their personality has changed
- they avoid friends and communicate less with you
- they seem unhappier than usual.
Why do depression and ADHD sometimes occur together?
Because ADHD tends to make children underachieve, they can start to feel demoralised. However, depression is more than this.
One study showed that children with ADHD, who have difficulty with social relationships, are more likely to suffer depression than those who are having general difficulties at school.
How common is depression with ADHD?
Overall, depression is rare before the age of eight. Between the ages of eight and puberty, it's thought to be around 2 to 4 per cent. After puberty, it's around 4 to 8 per cent. It's more common in girls than in boys.
Because depression is hard to diagnose in children, rates in children with ADHD vary widely.
Studies suggest up to a third of children with ADHD experience depression, and children who have ADHD are three times as likely to have depression as children who don't.
How is depression diagnosed?
There isn't a physical test, such as a blood test, to diagnose depression.
A child psychiatrist or clinical psychologist will talk to the child and the parents to:
- discuss how your child feels and assess the symptoms
- check the symptoms don't have a physical cause, such as a reaction to medication
- check the symptoms aren't connected with a major event such as bereavement.
For a clinical diagnosis:
- your child must have at least five symptoms of depression for at least two weeks
- at least one of the symptoms must be either depressed mood, irritability or loss of interest
- the symptoms mustn't be caused by another medical condition or a reaction to medication.
How is depression treated and how does it affect the treatment for ADHD?
Cognitive behavioural therapy (CBT) helps overcome negative thinking.
Children, usually from the age of ten years and upwards, are given the opportunity to discuss their thoughts and feelings in a non judgemental sympathetic setting.
It can also help your child to solve problems, do more things he likes and teach better social skills.
A course tends to be 8 to 12 weekly sessions.
The first 40 minutes with the child alone, the last 10 minutes with parents joining in.
Depression is usually treated by a child psychiatrist or clinical psychologist, together with your GP.
The actual treatment depends on how old your child is and severity of the symptoms. Below are some of the treatment options.
- Education: the therapist explains the condition to the child's parents and teachers, so they can help support the child.
- Psychotherapy: the therapist sees your child alone and talks with him. One particular type of psychotherapy used to treat depression is a talking treatment called cognitive behavioural therapy (CBT).
- Drug treatments: if your child is on medication for ADHD, this will continue. If psychotherapy doesn't work, or if your child continues to lose weight or have sleep problems or suicidal thoughts, the doctor may prescribe antidepressants.
Antidepressants in childhood
SSRIs are a type of antidepressant medication.
SSRI stands for selective serotonin re-uptake inhibitor.
A type of antidepressant medication, called selective serotonin re-uptake inhibitors (SSRI), is the first choice to treat childhood and adolescent depression.
The SSRI licensed for treatment of childhood depression in the UK is fluoxetine and this is the most widely prescribed.
Occasionally a psychiatry specialist may choose and alternative but this is unusual and reserved for treatment resistant or complex situations.
What if my child is taking an SSRI such as fluoxetine?
Young people taking SSRIs should not be suddenly taken off treatment.
Treatment always needs to be tailored to an individual's needs.
If an SSRI appears to be working, the decision may still be to continue with it.
All antidepressants have a delay of at least two weeks before they start to work, and often this delay can be up to six weeks.
This early stage of treatment is when any side-effects are at their greatest, so persevering with treatment is important if these effects are tolerable.
All antidepressants should be started gradually and taken for at least six months. Your doctor will advise when your child is ready to come off medication although antidepressants should be withdrawn slowly, over about six weeks.
How long will depression last?
Depression doesn't last any longer in a child with ADHD, than a child without ADHD.
In general, depression tends to last for less than nine months. Studies show that after a year, up to 80 per cent of children are better.
However, 50 per cent of children with depression are likely to have another depressive episode within two months. Around 10 per cent of children with depression find their condition is persistent.
Continuing contact with your family doctor and ADHD team will ensure ongoing help if your child has depression.
Want to know more on ADHD?
Worried about your child's behaviour? Sometimes it can be hard to work out whether a child's behaviour is normal or the sign of a behavioural disorder.
What is ADHD? Find out what the symptoms are.
What causes ADHD? Scientific research suggests the causes could be largely genetic, combined with some other factors.
Why is ADHD controversial? We look at what the problems are.
Not just a childhood disorder: How is it different to childhood ADHD?
How do I know if I have ADHD? Here are the signs and symptoms.
Getting help: Steps to diagnosis and treatment in adults.
Teenagers with ADHD: Tips for tackling problem behaviour.
One to one: ADHD can have a marked effect on relationships in the teenage years.
Work and ADHD: Find out about ADHD in the workplace.
Study and ADHD: Listed below are things to consider when choosing a course and some practical tips to help you study.
Tourettes: What is Tourette's syndrome?