Depression in Children and Teens with Cancer

What is depression?

Depression is one of the most common mental health disorders. It is sometimes called:

• Clinical depression
• Major depression
• Major depressive disorder

A depressive disorder can develop at any age. Depression in children and teens is more likely after puberty.

Symptoms of depression include feeling sad, down, or hopeless, and loss of interest in hobbies or activities.

Occasional symptoms of depression are common for someone facing serious illness. But in a depressive disorder, symptoms are more severe, longer lasting, and affect daily function.

Clinical depression is a real illness. If your child has it, they need specialized treatment. This can include therapy or antidepressant medicine.

Symptoms of depression in children and teens

Occasional thoughts or feelings of sadness or low mood are normal when you are dealing with a serious illness. But some patients may have more severe and longer lasting symptoms. In a depressive disorder, symptoms are persistent and cause distress. They can also cause problems in activities of daily living.

Symptoms of depression in children and teens may include:

• Feeling down, low, sad, depressed, or irritable much of the time
• Loss of interest or pleasure in hobbies or activities
• Being easily bothered, annoyed, or frustrated
• Feelings of worthlessness, hopelessness, or guilt
• Withdrawal from friends and family
• Problems sleeping
• Trouble thinking or concentrating, not able to make decisions
• Restlessness, not able to be still or slowing of speech or movements
• Loss of appetite or change in eating habits
• Crying more than usual
• Fatigue
• Thoughts of death or suicide

Depression may look different in children and teens than it does in adults. Children and teens may be more irritable, angry, anxious, or defiant. They may also express more physical complaints. Or they may engage in risky behaviors.

If your child shows symptoms of depression, they may be referred to a mental health specialist. These may include:

• Psychologists
• Psychiatrists
• Social workers
• Counselors
• Other mental health providers

Risk of depression in children and teens with serious illness

A serious illness is a risk factor for depression. Having one or more risk factors does not mean your child will develop depression. But knowing risk factors can help families be more watchful. It can help them take steps to support mental health.

Risk factors that may contribute to depression in children and teens include:

• Chronic illness
• Earlier depressive episode
• Family history of depression or other mental illness
• Family stress or conflict
• Stressful life events or situations
• Trauma or stress during early childhood
  • Abuse
  • Neglect
  • Significant loss
• Problems at school
• Bullying or social isolation
• Traumatic brain injury
• Poor coping skills
• Lack of support resources
• Other mental health disorders
  • Substance use
  • Anxiety
  • ADHD
  • Learning disabilities

Other factors can affect mental health when living with serious illnesses. These include:

• Treatments and procedure
• Pain
• Side effects
• Medicines
• Hormone changes
• Poor nutrition
• Sleep problems
• Life disruptions

Your child may also struggle with accepting a “new normal” as they deal with long-term issues like:

• Physical limitations
• Body image
• Identity
• Ability to function at school or work
• Fertility
• Relationships
• Independence
• Survival

Grief and depression

Grief can be a risk factor for depression.

Having some symptoms of depression during bereavement does not mean a person has a depressive disorder. Each person has a unique experience of grief. But there are some general differences between grief and depression.

• During grief, a person usually experiences ups and downs of thoughts and emotions. In depression, mood tends to stay negative most of the time.
• During grief, a person is less likely to have low self-esteem or feelings of worthlessness. In depression, self-criticism and low self-worth is common.
• During grief, a person may wish to be reunited with a loved one in death. But these thoughts are different from thoughts or plans of suicide or wishing to die.

Understanding the differences between grief and depression can help match support resources to patient and family needs.

Types of depressive disorders

A mental health professional can diagnose mental health problems. Some of the disorders related to childhood depression include:

Managing symptoms of depression is important. Symptoms of depression can:

• Contribute to health problems and physical symptoms
• Interfere with cancer-related care and medical outcomes
• Affect personal relationships
• Make it hard to function at school or work
• Impact nutrition, sleep, physical activity, and other health behaviors
• Increase risk for other problems such as alcohol or substance use, smoking, or self-harm
• Increase risk for suicide

A depressive disorder can also occur along with mental health problems.

Depression treatment

Therapy for depression

Psychotherapy, or “talk therapy”, is a main treatment for depression.

One of the most effective types of psychotherapy for depression is  Cognitive Behavioral Therapy (CBT). CBT helps patients identify negative thoughts and behaviors and to react to situations in a more helpful way.

Psychotherapy may also focus on developing skills to:

• Solve problems
• Improve relationships
• Manage stress

Relaxation techniques, art therapy, music therapy, and play therapy may be helpful. Your child might also benefit from individual, group, or family therapy.

Antidepressant medicines

A doctor may prescribe medicine for depression. Antidepressants work overtime to treat a depressive disorder. Some patients may need a combination of medicines.

Medicines used to treat depression in children and teens may include:

• Fluoxetine (Prozac®)
• Sertraline (Zoloft®)
• Citalopram (Celexa®)
• Escitalopram (Lexapro®)
• Venlafaxine (Effexor®)
• Duloxetine (Cymbalta®)
• Bupropion (Wellbutrin®)

Anyone taking antidepressants needs regular doctor visits to make sure the medicines are working. They can also monitor any side effects. In rare cases, some medicines may prompt aggressive behavior or increase risk of suicide.

Follow your care team’s directions for medicines exactly. Your child should not take more than prescribed. They should not stop taking the medicine without medical supervision.

Be sure to let a member of your care team know if depression does not improve.

Questions to ask your doctor when prescribed an antidepressant medicine:

• When should symptoms of depression begin to improve?
• Are there any medicines or supplements that my child should not take while taking this medicine?
• What are the common side effects?
• What side effects should we be particularly concerned about?
• What should I do if my child misses a dose?
• How long will my child need this medicine?

Be sure to keep your full care team updated on any changes to your treatment plan or medications. Also, feel free to ask questions about any medicines your child is prescribed. You can also ask about any questions or concerns.

Medicines used to treat depression can be unsafe if:

• Taken more often than prescribed
• In greater amounts than prescribed
• Stopped too quickly

Ask your child’s care team before making any dose changes. Also, be sure to store medicines safely. Keep them out of the reach of children.

Children and teens with depression should be monitored for suicide risk and worsening of symptoms.

Your child may need ongoing therapy to prevent relapse of depression.

Tips for parents and caregivers

• Help children and teens talk about thoughts and emotions. Be supportive. Listen to your child. Children and teens experiencing depression may not talk about their feelings. They may avoid these discussions. Create a safe space for honest conversation. Remember that each person will have different communication styles and preferences.
• Encourage social support. Having a strong social support can help protect against depression. Help children and teens stay connected to friends and family and find ways to encourage meaningful relationships.
• Encourage activities and interests. Encourage your child to get involved with activities that interest them. Being involved in various activities can help.
• Identify triggers. Each person reacts to stressful events differently. Help your child identify triggers that cause negative thoughts or emotions. Be understanding when your child shares with you.
• Use resources and strategies to help manage depression. Depression can happen to anyone at any time. Developing coping skills, strategies, and resources can protect mental health and promote well-being.
• Encourage healthy behaviors, including exercise, healthy eating, and good sleep habits. Physical activity can help reduce symptoms of depression. Eating a healthy diet and getting enough sleep are also important. Set small goals and choose physical activities and healthy foods your child enjoys. Try to keep a regular sleep schedule. Limit distractions during rest time.
• Seek help if depression symptoms get worse. Depression can have a negative impact on health and medical outcomes. It is a real illness. Asking for help is not a sign of weakness.