Depression

Planning treatment

What is an assessment? 

When you first meet with a mental health professional they will talk with you to help understand: 

• whether what you are experiencing is depression 
• how your symptoms are affecting you 
• whether there are any risks your professional should be aware of (e.g., self-harm) 
• whether you might have any other mental or physical health conditions
• whether you have any family history of mental or physical health conditions

This is an assessment and will also include talking about anything which might be causing your depression, for example whether something stressful or upsetting has happened.  

There are different treatments for depression so the assessment will help your professional to think about which treatment might be right for you. After the assessment your professional should explain which treatments they would recommend and explain why those treatments might work best for you. They should also explain what the treatments involve and give you information about any other treatment options. 

Who decides what kind of treatment I have?

If you are over 16 then usually you will make decisions about your treatment, for example which option you prefer if there are a choice of treatments. You don’t have to make these decisions on your own though, many young people aged over 16 decide that they would like support from their parents or carers when making decisions about treatment.  

Some young people under the age of 16 will also be able to make treatment decisions on their own, but if that’s not possible then your parents or carers will be asked to make decisions about your treatment. However, even if your parents or carers make the decisions about your treatment, your mental health professional should still listen to your thoughts and preferences about the treatment options. You can find more information about how these decisions are made here.   

How do mental health professionals decide what kinds of treatment might help me?

Your professional will think about a range of factors which might be contributing to your depression and suggest treatment options which address these factors. These could include: 

• Biological factors: for example if a physical illness or medication might be linked to your depression. 
• Social factors: for example if you need support with learning or you are experiencing bullying or problems at home. These could be contributing to your depression or make recovery more difficult, so your professional should try to find ways to address these difficulties. 
• Psychological factors: depression can cause changes in how you think which in turn can make you feel depressed. Your relationships with family members could also be negatively affected by symptoms of depression (such as irritability or social withdrawal) which could make recovery more difficult. Psychological therapies for depression involve talking about problems in your life with a mental health professional. Your professional will help you to understand these problems better, think about how to improve things and find different ways of coping. Psychological therapies are also called talking therapies and could include you and your family, just you talking to a professional, or you in a group of other young people with similar difficulties. 

As well as thinking about all these factors, the treatment options your professional suggests will also depend on how severe your depression is (this is based on your symptoms and how they are affecting your life). National guidelines on how to treat depression recommend that treatment options are offered in a certain order and describe when you might be offered more than one treatment option at the same time. Your professional will be able to explain how this might work for you. 

Watchful waiting for mild depression

For about 10% of children and young people mild depression will improve without any treatment, so your professional might suggest ‘watchful waiting’ before starting treatment. Also, if your depression is linked to something difficult in your life (e.g. bullying) or biological factors (e.g. a side-effect of medication) then your professional might recommend addressing these and waiting to see if your depression improves. Your professional should keep in touch with you during this ‘watchful waiting’ time to see if your symptoms improve. 

If your depression doesn’t improve after 2 weeks then your professional should carry out a review (this is sometimes called a reassessment) and plan to start treatment. If after these two weeks the severity of your depression has changed from mild to moderate, then your professional will suggest treatment options for moderate depression. 

Are there any things I can do which might help?

There are a few things which many people find helpful. These won’t replace treatment for depression, but can be useful things to keep in mind: 

Try to keep eating well – this isn’t a specific treatment for depression but having a healthy diet can improve your physical and mental health. This is particularly important if depression has affected your appetite. See how other young people found eating a balanced diet helps them manage their mental health and wellbeing.

Try to get enough exercise – especially if you are doing less physical activity than usual. See how physical exercise helps other young people manage their mental health and wellbeing.

Try to get enough sleep – treatment for depression should help your sleep but sleep problems are common for people who are experiencing depression. If you are having problems with sleep then you should ask your mental health professional about extra things which could help. Usually, finding a good routine and healthy sleep habits can make a big difference. See how sleep helps other young people manage their mental health and wellbeing.

Try to limit any use of drugs or alcohol – talk to your professional about whether drugs or alcohol might be contributing to your depression. There is strong evidence that alcohol and drugs such as cannabis can have a negative effect on mood. See how other young people found reducing consumption of stimulants and other drugs helps them manage their mental health and wellbeing.

What about my parents or carers?

If you are over 16 then you can choose whether and how you want your parents or carers to be involved in your care. If you are younger than 16 then your professional will think about whether you are able to make these decisions on your own. For children and young people aged under 16 parents or carers would usually be involved in your care unless there’s a clear reason why this would be unhelpful.  

Usually, involving parents and carers is helpful and often parents and carers might be worried and want to know what they can do to support you. Your parents or carers might have noticed changes in you (including some that you might not have noticed in yourself). They can also help to give your mental health professional information on your life and medical history, including about your other family members and from when you were too young to remember. Your parents or carers could be involved in supporting your treatment and some treatments (such as family therapy) involve parents or carers in the treatment itself. This doesn’t mean that your parents or carers will know everything that happens in your individual sessions. You can find more information about confidentiality and privacy here and shared decision making here. 

The wellbeing of your parents or carers is important, and they might need support and advice themselves such as:  

• attending a parent or carer support group 
• psychological support for themselves 
• help with any practical issues, such as financial or housing problems, which might be affecting your family. 

Ending treatment

You and your parents or carers (if appropriate) should be involved in decisions about when you are ready to end treatment. Treatment will usually end when your low mood has been better and has had less impact on your life for at least two months. When your treatment ends, you should still have regular check-ins with a professional for at least a year. 

If your depression tends to come and go, you should keep having these check-ins for two years after your treatment has ended and your professional should talk with you about early warning signs that you might need more support. If you need more support after these two years, your professional should see you quickly after another referral. 

If you feel that things have been getting worse it’s important to discuss this at your check-ins, especially if you’ve experienced self-blame, suicidal thoughts, self-harm or self-destructive behaviour. Your professional should help you with an emergency plan and a support network to help you cope during difficult times. You can find more information on ending treatment here. 

Additional support

The below organisations offer depression specific support for children, young people and their families:

• AFC Crisis Messenger: a free, confidential, 24/7 text message support service for anyone who is feeling overwhelmed or is struggling to cope. If you need support, you text AFC to 85258
• Bipolar UK: charity providing peer support services for people affected by bipolar and bipolar depression
• CALM: Campaign Against Living Miserably’s website includes helpline and webchat for those who may be experiencing suicidal thoughts or affected by the suicide of someone else
• Charlie Waller: charity offering resources for young people affected by anxiety and/or depression
• Childline: Childline is there to help anyone under 19 in the UK with any issue they’re going through. Whether it’s something big or small, their trained counsellors are there to support you
• Samaritans: offering self-help support to those who are experiencing low mood and/or depression. They have websites offering support in Northern Ireland, Scotland and Wales
• Supportline: charity offering helpline for people of all ages on a wide range of issues including anger, eating disorders, self-harm, depression, anxiety, panic attacks, and addictions
• The Mix: support and advice for children and young people under 25