Depression in Children and Teens

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Depression in Children and Teens

Topic Overview

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This topic covers depression in children and teens. For information about depression in adults, see the topic Depression. For information about depression with episodes of high energy (mania), see the topic Bipolar Disorder in Children and Teens.

What is depression in children and teens?

Depression is a serious mood disorder that can take the joy from a child’s life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.

Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve. As many as 2 out of 100 young children and 8 out of 100 teens have serious depression.1

Still, many children don't get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.

If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. If you think your child is depressed, talk to your doctor or a counsellor. The sooner a child gets treatment, the sooner he or she will start to feel better.

What are the symptoms?

A child may be depressed if he or she:

  • Is grumpy, sad, or bored most of the time.
  • Does not take pleasure in things he or she used to enjoy.

A child who is depressed may also:

  • Lose or gain weight.
  • Sleep too much or too little.
  • Feel hopeless, worthless, or guilty.
  • Have trouble concentrating, thinking, or making decisions.
  • Think about death or suicide a lot.

The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.

Also, the symptoms may be different depending on how old the child is.

  • Very young children may lack energy and become withdrawn. They may show little emotion, seem to feel hopeless, and have trouble sleeping.
  • Grade-school children may have a lot of headaches or stomach aches. They may lose interest in friends and activities that they liked in the past. Some children with severe depression may see or hear things that aren't there (hallucinate) or have false beliefs (delusions).
  • Teens may sleep a lot or move or speak more slowly than usual. Teens with severe depression may hallucinate or have delusions.

Depression can range from mild to severe. A child who feels a little "down" most of the time for a year or more may have a mild, ongoing form of depression called dysthymia (say "dis-THY-mee-uh"). In its most severe form, depression can cause a child to lose hope and want to die.

Whether depression is mild or severe, there are treatments that can help.

What causes depression?

Just what causes depression is not well understood. But it is linked to an imbalance of brain chemicals that affect mood. Things that may cause these chemicals to get out of balance include:

  • Stressful events, such as changing schools, going through a divorce, or having a death in the family.
  • Some medicines, such as steroids or narcotics for pain relief.
  • Family history. In some children, depression seems to be inherited.

How is depression diagnosed?

To diagnose depression, a doctor may do a physical examination and ask questions about the child's past health. You may be asked to fill out a form about your child’s symptoms. The doctor may ask your child questions to learn more about how the child thinks, acts, and feels.

Some diseases can cause symptoms that look like depression. So the child may have tests to help rule out physical problems, such as a low thyroid level or anemia.

It is common for children with depression to have other problems too, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems to help your child get the right diagnosis and treatment.

How is it treated?

Usually one of the first steps in treating depression is education for the child and his or her family. Teaching both the child and the family about depression can be a big help. It makes them less likely to blame themselves for the problem. Sometimes it can help other family members see that they are also depressed.

Counselling may help the child feel better. The type of counselling will depend on the age of the child. For young children, play therapy may be best. Older children and teens may benefit from cognitive-behavioural therapy. This type of counselling can help them change negative thoughts that make them feel bad.

Medicine may be an option if the child is very depressed. Combining antidepressant medicine with counselling often works best. A child with severe depression may need to be treated in the hospital.

There are some things you can do at home to help your child start to feel better.

  • Urge your child to get regular exercise, eat a healthy diet, and get enough sleep.
  • See that your child takes any medicine as prescribed and goes to all follow-up appointments.
  • Make time to talk and listen to your child. Ask how he or she is feeling. Express your love and support.
  • Remind your child that things will get better in time.

What should you know about antidepressant medicines?

Antidepressant medicines often work well for children who are depressed. But there are some important things you should know about these medicines.

  • Children who take antidepressants should be watched closely. These medicines may increase the risk that a child will think about or try suicide, especially in the first few weeks of use. If your child takes an antidepressant, learn the warning signs of suicide, and get help right away if you see any of them. Common warning signs include:
    • Talking, drawing, or writing about death.
    • Giving away belongings.
    • Withdrawing from family and friends.
    • Having a way to do it, such as a gun or pills.
  • Your child may start to feel better after 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressants as prescribed and keeps taking them so they have time to work.
  • A child may need to try several different antidepressants to find one that works. If you notice any warning signs or have concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child's doctor.
  • Do not let a child suddenly stop taking antidepressants. This could be dangerous. Your doctor can help you taper off the dose slowly to prevent problems.

Frequently Asked Questions

Learning about depression in children and teens:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with depression in children and teens:

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  Depression: Should My Child Take Medicine to Treat Depression?

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  Depression: Dealing With Medicine Side Effects
  Depression: Taking Antidepressants Safely

Cause

Depression is thought to be caused by an imbalance of chemicals called neurotransmitters that send messages between nerve cells in your brain. Some of these chemicals, such as serotonin, help regulate mood. If these mood-influencing chemicals get out of balance, depression or other mood disorders can result. Experts have not yet identified why neurotransmitters become imbalanced. They believe a change can occur as a response to stress or illness. But a change may also occur with no obvious trigger.

There are several things known to increase the chances that a young person may become depressed.

  • Depression runs in families. Children and teens who have a parent with depression are more likely to develop depression than children with parents who are not depressed. Experts believe that both inherited traits (genetics) as well as living with a parent who is depressed can cause depression.
  • Depression in children and teens may be linked to stress, social problems, and unresolved family conflict. It can also be linked to traumatic events, such as violence, abuse, or neglect.
  • Children or teens who have long-term or serious medical conditions, learning problems, or behaviour problems are more likely to develop depression.
  • Some medicines can trigger depression, such as steroids or narcotics for pain relief. As soon as the medicine is stopped, symptoms usually disappear.

Symptoms

The symptoms of depression are often subtle at first. They may occur suddenly or happen slowly over time. It can be hard to recognize that symptoms may be connected and that your child might have depression.

Children who are depressed may have the following symptoms:

  • Physical symptoms:
    • Unexplained aches and pains, such as headaches or stomach pain
    • Trouble sleeping, or sleeping too much
    • Changes in eating habits that lead to weight gain or loss or not making expected weight gains
    • Constant tiredness, lack of energy
    • Body movements that seem slow, restless, or agitated
  • Mental or emotional symptoms:
    • Irritability or temper tantrums
    • Difficulty thinking and making decisions
    • Having low self-esteem, being self-critical, and/or feeling that others are unfairly critical
    • Feelings of guilt and hopelessness
    • Social withdrawal, such as lack of interest in friends
    • Anxiety, such as worrying too much or fearing separation from a parent
    • Thinking about death or feeling suicidal

It's important to watch for warning signs of suicide in your child or teen. These signs may change with age. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.

Depression can have symptoms that are similar to those caused by other conditions.

Less common symptoms

Severely depressed children may also have other symptoms, such as:

  • Hearing voices that aren't there (hallucinations). This is more common in young children.
  • Having false but firmly held beliefs (delusions). This is more common in teens.

Is it normal moodiness or depression?

Telling the difference between normal moodiness and symptoms of depression can be hard. Occasional feelings of sadness or irritability are normal. They allow the child to process grief or cope with the challenges of life.

For example, grieving (bereavement) is a normal response to loss, such as the death of a family member or even the death a pet, loss of a friendship, or parents' divorce. After a severe loss, a child may remain sad for a longer period of time.

But when these emotions do not go away or begin to interfere with the young person's life, he or she may need treatment.

Bipolar disorder

Some children who are first diagnosed with depression are later diagnosed with bipolar disorder. Children or teens with bipolar disorder have extreme mood swings between depression and bouts of mania (very high energy, agitation, or irritability).

It can be hard to tell the difference between bipolar disorder and depression. It is common for children with bipolar disorder to first be diagnosed with only depression and later to be diagnosed with bipolar disorder after a first manic episode. Although depression is part of the condition, bipolar disorder requires different treatment than depression alone.

Like depression, bipolar disorder runs in families. So be sure to tell your doctor if your child has a family history of bipolar disorder. For more information on bipolar disorder, see the topic Bipolar Disorder in Children and Teens.

What Happens

At first, depression in a child or teen may appear as irritability, sadness, or sudden, unexplained crying. He or she may lose interest in activities enjoyed in the past or may feel unloved and hopeless. He or she may have problems in school and become withdrawn or defiant.

An episode of depression lasts an average of 8 months.1 Even with successful treatment, as many as 40 out of 100 children with depression will have another episode within a few years.2

Less than half of children and teens with depression receive treatment.3 This may be partly due to the old belief that young people don't get depression.

Also, teens often do not seek help for depression. They may think feeling bad is normal, they may blame something else (or themselves) for their symptoms, or they may not know where to go for help. Tell your child to ask for help if he or she feels bad. And let your child know who to go to for help with depression or other problems.

Drugs and alcohol

Some teens will have alcohol or drug use problems along with depression. When this happens, depression is harder to treat, and it can take longer for treatment to work. Drug or alcohol use also increases the risk of suicide.

Early diagnosis and treatment of depression and good communication with your child can help prevent substance abuse. For more information about substance abuse in young people, see the topic Teen Alcohol and Drug Abuse.

Often a child who is depressed will have other disorders along with depression, such as an anxiety disorder, a behaviour disorder like attention deficit hyperactivity disorder (ADHD), an eating disorder, or a learning disorder. These problems may occur before a young person becomes depressed. Some children with depression develop serious behaviour problems (conduct disorder), often after becoming depressed. If your child has one of these disorders, it may require treatment along with depression.

Other problems

Children and teens with depression are also at a higher risk for problems such as:

  • Poor school or job performance.
  • Problems in relationships with peers and family members.
  • Early pregnancy.
  • Physical illness.

For severe depression, your child may need to be hospitalized, especially if he or she is out of touch with reality (psychotic) or is having thoughts of suicide.

Relapse

During treatment for depression, make sure that your child takes medicines and attends counselling appointments as directed, even if he or she feels better. A common cause of relapse is stopping treatment too soon.

Suicide and depression

It's very important to recognize the warning signs of suicide in your child or teen. You should carefully watch for signs of suicidal behaviour if your child has recently:

  • Broken up with a girlfriend or boyfriend.
  • Had disciplinary troubles in school or with the law.
  • Had problems with poor grades or had trouble learning.
  • Had family problems.
  • Had substance abuse problems.
  • Started, stopped, or changed doses of an antidepressant medicine.

It is extremely important that you take all threats of suicide seriously and seek immediate treatment for your child or teenager. If you are a child or teen and have these feelings, talk with your parents, an adult friend, or your doctor right away to get some help. If your child is suicidal, call 911 or other emergency services immediately.

What Increases Your Risk

Several things increase a young person's chance of developing depression. These include:1

  • Having a parent or immediate family member who is depressed. This is the most important risk factor for depression. Children or teens who have a parent with depression are 3 times more likely to develop depression.
  • Having been depressed before, especially if depression first occurred at an early age.
  • Having a long-term medical condition such as diabetes or epilepsy.
  • Having another mental disorder, such as conduct disorder or an anxiety disorder.
  • Having a family member or close friend die.
  • Being physically or sexually abused.
  • Having problems with alcohol or drug abuse.

Other risk factors for depression include:

  • Being a girl in early puberty. Until puberty, boys and girls have an equal risk of developing depression. After puberty and as adults, females are twice as likely as males to become depressed.
  • Being exposed to family conflict.
  • Not having good social relationships with peers.
  • Being a bully or a victim of bullying.4

When To Call a Doctor

Call 911 or other emergency services immediately if:

  • Your child makes threats or attempts to harm himself or herself or another person, or shows other warning signs of suicide.
  • Your child hears voices (has auditory hallucinations).
  • You are a young person and you feel you cannot stop from harming yourself or someone else.

Watchful Waiting

Taking a wait-and-see approach, called watchful waiting, may be appropriate if your child has feelings of grief, sadness, or melancholy.

But you should contact a doctor right away if symptoms of depression last more than 2 weeks or if your child's symptoms are interfering with his or her normal daily functioning.

The warning signs of suicide change with age. Warning signs of suicide in children and teens may include preoccupation with death or suicide or a recent breakup of a relationship.

Who To See

Treatment for depression may involve professional counselling, medicines, education about depression for your child and your family, or a combination of these. It is important that your child establish a long-term and comfortable relationship with the care providers for the treatment of depression.

Your child may be diagnosed and treated by your family doctor, general practitioner, or pediatrician. Your child may be referred to other health professionals for counselling (or psychotherapy), such as a psychiatrist or psychologist.

Other health professionals who also may be trained in counselling include a:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

Your doctor or another health professional will evaluate and diagnose depression in your child by asking questions about your child's medical history and conducting tests to find out if symptoms are caused by something other than depression. Your child may be given a physical examination or blood tests to rule out conditions such as hypothyroidism and anemia. Your child may be asked to complete a mental health assessment, which tests his or her ability to think, reason, and remember.

You may be asked to help complete a pediatric symptom checklist, a brief screening questionnaire that helps to diagnose depression or other psychological problems in children. Also, your child may be asked to take a short written or verbal test for depression.

Sometimes a more thorough evaluation may be needed to fully assess your child's depression. Interviews may be conducted with the parents or with other people who know the young person well. Specific information may be obtained from the child's teachers or from social service workers.

Treatment Overview

The sooner treatment begins for depression, the sooner your child is likely to recover. Waiting to seek treatment for depression may mean a longer and more difficult recovery.

Treatment generally includes professional counselling, medicines, and education about depression for your child and your family.

Home treatment is an important part of treating depression. It includes regular exercise, healthy eating, and getting enough sleep. For more information, see the Home Treatment section of this topic.

Counselling

Professional counselling for depression includes several types of therapy, such as cognitive-behavioural therapy and family therapy. For more information about counselling, see the Other Treatment section of this topic.

Medicines

Medicines used to treat childhood depression include several types of drugs called antidepressants.

An important part of treatment is making sure that your child takes medicines as prescribed. Often people who feel better after taking an antidepressant for a period of time may feel like they are "cured" and no longer need treatment. But when medicine is stopped too early, symptoms usually return. So it is important that your child follows the treatment plan.

Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories stating that people who are taking antidepressants for depression, along with their family members and their doctors, should watch for warning signs of suicide. Before prescribing medicine, your doctor will check your child for possible suicidal thoughts by asking a few questions. See a list of questions your doctor may ask your child.

For more information on antidepressants, see the Medications section of this topic.

Education

Education of your child and family members can be provided by a doctor either informally or in family therapy. Some of the most important things that your child and family members can learn include:

  • Knowing how to make sure a child is following a treatment plan, such as taking medicine correctly and going to counselling appointments.
  • Learning ways to reduce stress caused by living with someone who has depression.
  • Knowing the signs of a relapse and what to do to prevent depression from recurring.
  • Knowing the signs of suicidal behaviour, how to evaluate their seriousness, and how to respond.
  • Learning how to identify signs of a manic episode, which is a bout of extremely high mood and energy, or irritability that is a sign of bipolar disorder.
  • Seeking treatment if you are a parent with depression. If a parent's depression goes untreated, it may interfere with the recovery of the child.

Additional treatment

Your child may need treatment for other disorders that may be causing ongoing symptoms, such as:

A brief hospital stay may be needed, especially if your child:

  • Is showing any warning signs of suicide (such as aggressive or hostile behaviour, excessive thoughts about death, or detachment from reality).
  • Is so depressed that he or she becomes out of touch with reality (psychotic) or has hallucinations or delusions.

If your child is depressed, consider removing all guns and potentially fatal medicines from your home, especially if your child has shown any warning signs of suicide. Although overdosing on medicine is the most common way that teens attempt suicide, your child is at higher risk for completing a suicide if you have a gun in your home, particularly if it is easy to get to it or if you store it loaded.5

Prevention

It is difficult to prevent a first episode of depression, but it may be possible to prevent or reduce the severity of future episodes of depression (relapses).

  • There is some evidence that if a child receives cognitive-behavioural therapy (CBT) in a group setting, it can help prevent or delay the onset of depression in a child or teen whose parent has depression (which puts the child at greater risk for becoming depressed).6
  • Your child must take medicines as prescribed, keep counselling appointments, eat a balanced diet, and get regular exercise. For more information, see the topic Physical Activity for Children and Teens.
  • Make sure that your child has a good social support system, both at home and through teachers, other family members, and friends who can provide encouragement and understanding.
  • Learn to recognize early symptoms of depression, and seek immediate diagnosis and treatment if they occur.
  • Some schools provide educational materials and group therapy opportunities to those at high risk for depression, such as those who have family conflict or problems with peers.

Home Treatment

Do everything possible to provide a supportive family environment. Love, understanding, and regular communication are some of the most important things you can provide to help your child cope with depression.

In addition to having a positive home life, staying in professional counselling, and taking medicines as prescribed, good lifestyle habits can help reduce your child's symptoms of depression. Encourage your child to:

  • Get regular exercise, such as swimming, walking, or playing vigorously every day. For more information, see the topic Physical Activity for Children and Teens.
  • Avoid alcohol and illegal drugs, non-prescription medicines, herbal therapies, and medicines that have not been prescribed (because they may interfere with the medicines used to treat depression).
  • Get enough sleep. If your child has problems sleeping, he or she might try:
    • Going to bed at the same time every night.
    • Keeping the bedroom dark and quiet.
    • Not exercising after 5:00 p.m.
  • Eat a balanced diet. If your child lacks an appetite, try to get him or her to eat small snacks rather than large meals.
  • Be hopeful about feeling better. Positive thinking is very important in recovering from depression. It is difficult to be hopeful when you feel depressed, but remind your child that improvement occurs gradually and takes time.

If you notice any warning signs of suicide (such as aggressive or hostile behaviour, excessive thoughts about death, or detachment from reality) seek professional help immediately by calling either your child's doctor, a professional counsellor, or a local mental health or emergency services. Call 911 if you feel your child is in immediate danger.

Medications

Although experts believe that, for many children with depression, the benefits of medicine outweigh the risks, research on antidepressant medicine in children is limited. The long-term effects and safety of medicines used to treat depression in children and teens are still unknown.

You may have heard about concerns regarding a possible connection between antidepressant medicines and suicidal behaviour. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories about this issue.

Especially during the first few weeks of treatment with an antidepressant, there is a possible increase in suicidal feelings or behaviour. A child beginning antidepressant treatment should be watched closely. But children with untreated depression are also at an increased risk for suicide. So it is important to carefully weigh all of the risks and benefits of antidepressant medicine.

Medication Choices

Medicine choices include:

What to Think About

Antidepressant medicines such as fluoxetine (Prozac, for example) can be effective in treating depression, but it may take 1 to 3 weeks before your child starts to feel better. It can take as many as 6 to 8 weeks to see more improvement. Make sure your child takes antidepressant medicines as prescribed and keeps taking them so they have time to work. If you have any questions or concerns about the medicine, or if you do not notice any improvement by 3 weeks, talk to your child's doctor.

SSRIs may also be effective in treating other conditions such as anxiety.

Your child may have to try several medicines before the most effective treatment is discovered. After the right medicine is found, your child may need to continue taking the medicine for several months or longer after the symptoms of depression have subsided, to prevent depression from occurring again.

Some children who are first diagnosed with depression are later diagnosed with bipolar disorder, which has symptoms that cycle from depression to mania (very high energy, often with euphoria, agitation, irritability, risk-taking behaviour, or impulsiveness). If your child or teen has bipolar disorder, a first episode of mania can happen spontaneously. But it can also be triggered by certain medicines such as stimulants or antidepressants. That is why it is very important to tell your child's doctor about any family history of bipolar disorder and to watch your child closely for signs of manic behaviour. For more information about bipolar disorder in young people, see the topic Bipolar Disorder in Children and Teens.

Click here to view a Decision Point. Depression: Should My Child Take Medicine to Treat Depression?
Click here to view an Actionset. Depression: Taking Antidepressants Safely
Click here to view an Actionset. Depression: Dealing With Medicine Side Effects

Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories stating that people who are taking antidepressants for depression, along with their family members and their doctors, should watch for warning signs of suicide. Before prescribing medicine, your doctor will check your child for possible suicidal thoughts by asking a few questions. See a list of questions your doctor may ask your child.

Other Treatment

Besides taking medicine, other treatment for depression includes professional counselling and electroconvulsive therapy.

Complementary medicines such as St. John's wort have been used to treat depression in adults. But there is no evidence that these therapies are safe for use by children or teens.2 They can also interfere with other medicines, such as antidepressants.

Other Treatment Choices

  • Types of counselling most often used to treat depression in children and teens are:
    • Cognitive-behavioural therapy, which helps reduce negative patterns of thinking and encourages positive behaviours.
    • Interpersonal therapy, which focuses on the child's relationships with others.
    • Problem-solving therapy, which helps the child deal with current problems.
    • Family therapy, which provides a place for the whole family to express fears and concerns and learn new ways of getting along.
    • Play therapy, which is used with young children or children with developmental delays to help them cope with fears and anxieties. But there is no proof that this type of treatment reduces symptoms of depression.
  • Electroconvulsive therapy (ECT) may be an effective treatment for a teen or older child who is severely depressed or does not respond to other treatment, although this treatment is rarely used for children and teens. Even though it is an effective treatment for adults with major depression, there are currently no long-term studies on the safety of using ETC.2

What to Think About

Health Canada has approved the vagus nerve stimulator (VNS) implant for treatment of depression in adults. This device may be used when other treatments for depression have not worked.

A generator the size of a pocket watch is placed in the chest. Wires go up the neck from the generator to the vagus nerve. The generator sends tiny electric shocks through the vagus nerve to that part of the brain that is believed to play a role in mood.

How well the VNS implant works for children has not been well studied, and the device is expensive.7

Other Places To Get Help

Organizations

Canadian Mental Health Association
595 Montreal Road
Suite 303
Ottawa, ON  K1K 4L2
Phone: (613) 745-7750
Fax: (613) 745-5522
Email: info@cmha.ca
Web Address: www.cmha.ca
 

The Canadian Mental Health Association (CMHA) promotes mental health and focuses on combatting mental health problems and emotional disorders. The organization offers workshops, pamphlets, newsletters, and other educational materials.


Canadian Psychiatric Association
141 Laurier Avenue West
Suite 701
Ottawa, ON  K1P 5J3
Phone: (613) 234-2815
Fax: (613) 234-9857
Email: cpa@cpa-apc.org
Web Address: www.cpa-apc.org

Kids Help Phone
300-439 University Avenue
Toronto, ON  M5G 1Y8
Phone: 1-800-668-6868 (hotline number for kids and youth)
(416) 586-5437 (national office)
Fax: (416) 586-0651
Email: info@kidshelp.sympatico.ca
Web Address: www.kidshelpphone.ca
 

Kids Help Phone provides children and teens access to counsellors 24 hours a day, seven days a week. Counsellors also respond to questions posted online. At the Web site, visitors can find information on issues specific to children and teens, such as on bullying, dating, girls' and boys' health, and violence and abuse.


Mood Disorders Society of Canada
3-304 Stone Road West
Suite 736
Guelph, ON  N1G 4W4
Phone: (519) 824-5565
Fax: (519) 824-9569
Email: info@mooddisorderscanada.ca
Web Address: www.mooddisorderscanada.ca

Public Health Agency of Canada (PHAC)
130 Colonnade Road
A.L. 6501H
Ottawa, ON  K1A 0K9
Phone: Telephone numbers for PHAC vary by region. For your regional number, go to the listing on the PHAC website at www.phac-aspc.gc.ca/contac-eng.php.
Web Address: www.phac-aspc.gc.ca/index-eng.php
 

The Public Health Agency of Canada (formerly the Population and Public Health Branch of Health Canada) is primarily responsible for policies, programs, and systems relating to disease prevention, health promotion, disease surveillance, community action, and disease control.


References

Citations

  1. Wagner KD, Brent DA (2009). Depressive disorders and suicide. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3652–3663. Philadelphia: Lippincott Williams and Wilkins.
  2. Hazell P (2009). Depression in children and adolescents, search date April 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  3. Substance Abuse and Mental Health Services Administration (2008). Major depressive episode and treatment among adolescents. National Survey on Drug Use and Health (NSDUH) Report. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available online: http://oas.samhsa.gov/2k9/youthDepression/MDEandTXTforADOL.htm.
  4. Saluja G, et al. (2004). Prevalence of and risk factors for depressive symptoms among young adolescents. Archives of Pediatric and Adolescent Medicine, 158(8): 760–765.
  5. Brent DA, Birmaher B (2002). Adolescent depression. New England Journal of Medicine, 347(9): 667–671.
  6. Garber J, et al. (2009). Prevention of depression in at-risk adolescents: A randomized controlled trial. JAMA, 301(21): 2215–2224.
  7. Vagus nerve stimulation for depression (2005). Medical Letter on Drugs and Therapeutics, 47(1211): 50–51.

Other Works Consulted

  • American Psychiatric Association (2000). Seasonal pattern section of Mood disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 425–427. Washington, DC: American Psychiatric Association.
  • Ascherman LI, et al. (2006). Mental development and behavioral disorders. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1213–1219. Philadelphia: Saunders.
  • Baloch HA, Soares JC (2010). Mood disorders. In EG Nabel, ed., ACP Medicine, section 13, chap. 2. Hamilton, ON: BC Decker.
  • Birmaher B, Brent DA, et al. (2000). Clinical outcomes after short-term psychotherapy for adolescents with major depressive disorder. Archives of General Psychiatry, 57(1): 29–36.
  • Brent DA, Wheersing VR (2007). Depressive disorders. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 503–513. Philadelphia: Lippincott Williams and Wilkins.
  • Klein DN, et al. (2001). A family study of major depressive disorder in a community sample of adolescents. Archives of General Psychiatry, 58(1): 13–20.
  • March JS, et al. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) Randomized Controlled Trial. JAMA, 292(7): 807–820.
  • Mrazek DA, Mrazek PJ (2007). Prevention of depression and suicide in children and adolescents. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 171–177. Philadelphia: Lippincott Williams and Wilkins.
  • Sass AE, Kaplan DW (2011). Depression section of Adolescence. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 116–118. New York: McGraw-Hill.
  • Wagner KD, Brent DA (2009). Depressive disorders and suicide. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3652–3663. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Lisa S. Weinstock, MD - Psychiatry
Last Revised May 31, 2011

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