Pediatric Persistent Depressive Disorder

Persistent depressive disorder is a type of depression. Depression affects a child’s body, mood and thoughts. It can disturb eating, sleeping or thinking patterns. It's not the same as being unhappy or in a blue mood. It's also not a sign of weakness. It can’t be willed or wished away. Children with depression can’t just pull themselves together and get better. Treatment is often needed.

With persistent depressive disorder, a child has a low, sad or grouchy mood for at least one year. They may also have major depressive episodes at times.

This type of depression has no single cause. Many factors, such as genetics and the environment, play a role. Depression often happens with other mental health disorders, such as substance abuse or anxiety disorders. Depression in children can be set off by things. These include a sudden illness, a stressful event or a loss of someone important.

These are the most common risk factors for depression:

• Family history, especially if a parent had depression when young
• Lots of stress
• Abuse or neglect
• Physical or emotional trauma
• Other mental health problems
• Loss of a parent, caregiver or other loved one
• Loss of a relationship, such as moving away or losing a boyfriend or girlfriend
• Other long-term health problems, such as diabetes
• Other developmental or learning problems

Each child’s symptoms may vary. A child must have two or more of the following symptoms for at least one year to be diagnosed with persistent depressive disorder:

• Lasting feelings of sadness
• Feelings of despair, helplessness or guilt
• Low self-esteem
• Feelings of not being good enough
• Feelings of wanting to die
• Trouble with relationships
• Sleep problems, such as insomnia
• Changes in appetite or weight
• A drop in energy
• Problems focusing or making decisions
• Being grouchy, hostile or aggressive
• Suicidal thoughts. Take any comments about suicide seriously. Get help right away.
• Suicide attempts. An attempt means someone harms themselves in a way that is meant to end their life, but they do not die because of their actions. This is an emergency. Get immediate help.
• Frequent physical complaints, such as headache, stomachache or extreme tiredness or exhaustion (fatigue)
• Running away or threats of running away from home
• Loss of interest in normal activities or activities once enjoyed
• Sensitivity to failure or rejection

Persistent depressive disorder symptoms may look like other mental health problems. Take your child to their healthcare provider for a diagnosis. Major depression may be diagnosed when a teen has at least five symptoms of depression on most days, lasting for more than two weeks.

A child with this disorder may have other health problems, such as substance abuse or an anxiety disorder. So early diagnosis of other medical and mental health problems and treatment is important to your child getting better.

A mental health expert often diagnoses this disorder. They will do a comprehensive mental health evaluation. They may also talk with family, teachers and caregivers.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how bad the condition is.

This disorder can be treated. Children may need to try different therapists and therapies before they find what works. Treatment may include:

• Medicines. Antidepressant medicines can be very helpful, especially when used with psychotherapy.
• Talk therapy (psychotherapy). This treatment helps children with depression change their distorted views of themselves and the environment around them. It also finds stressors in the child’s environment and teaches them how to stay away from them or manage them if prevention isn't possible. A child also learns how to work through hard relationships.
• Family therapy. Parents play a vital role in treatment.
• School assistance. A child’s school, including counselors, may also be included in care.  

Persistent depressive disorder may put your child at an increased risk for major depression if they do not get the correct treatment. It also raises the risk for your child or teen to have other mental health disorders. And it can result in a severe reduction in your child's long-term quality of life. Effective treatment helps to make symptoms less severe. It also reduces the risk of having another depressive episode (called a relapse).

A child with this disorder may have times of depression that last longer than five years. Correct, ongoing treatment can ease symptoms and stop them from returning.

Experts don’t know how to prevent persistent depressive disorder in a child. But spotting it early and getting expert help for your child can help ease symptoms. It can improve your child’s quality of life.

You play a key role in your child’s treatment. Here are things you can do to help your child:

• Keep all appointments with your child’s healthcare provider.
• Give medicines as prescribed. Don't increase or decrease the dose unless you talk to your child's healthcare provider. Never share your child's medicines or use another person's, even if it's the same medicine and dose.
• Listen to your child. Find out about what they worry about, what they enjoy, how they like to spend their day. Make time to be alone with your child in a nonstressful activity, doing something they enjoy.
• Focus on your child's strengths. Offer encouragement and help them look at problems as challenges that can be managed.
• Look at your relationship with your child. Consider if your expectations for your child are reasonable. A child's fear of disappointing parents can result in anxiety and increased depressive symptoms.
• Keep track of your child's social media activity. Try to keep online time balanced with exercise and time outdoors. Watch for any online bullying.
• Talk with your child’s healthcare provider about other providers who will be included in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists and psychiatrists. Your child’s care team will depend on your child’s needs and how serious their depression is.
• Tell others who need to know about your child’s disorder. Work with your child’s healthcare provider and schools to create a treatment plan.
• If depression significantly interferes with your child’s ability to succeed in school, they may be eligible for specific protections and reasonable accommodations under the Americans with Disabilities Act (ADA) or Section 504 of the Civil Rights Act. Talk with your child’s teacher or school principal about how to get more information.
• Reach out for support from local community services. Being in touch with other parents who have a child with this disorder may be helpful.
• Let your child know they can talk to you about anything, anytime. This openness is especially important if your child starts to think about hurting themselves or attempting suicide.

Call your child’s healthcare provider right away if your child:

• Feels extreme depression, fear, anxiety or anger toward themselves or others
• Feels out of control
• Hears voices that others don’t hear
• Sees things that others don’t see
• Can’t sleep or eat for three days in a row
• Shows behavior that concerns friends, family or teachers, and others express concern about your child’s behavior and ask you to get help
• Call or text 988 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan. You will be connected to trained crisis counselors at the 988 Suicide & Crisis Lifeline. An online chat choice is also available at 988lifeline.org. You can also call Lifeline at 800-273-TALK (800-273-8255). Lifeline is free and available 24/7.
• If your child has a phone, make sure they have emergency numbers in their phone. These may include parents, other trusted adults, a healthcare provider and the Lifeline. Help your child understand that reaching out for help is the most important thing to do if they are thinking about self-harm.
• If your child expresses suicidal thoughts, first get care right away, then make sure all dangerous items in your home are not in reach of your child. Remove knives and other sharp objects. Lock up guns and ammunition in separate locations. Lock up all medicines and alcohol.