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Depression in Children

Depression is a mental illness marked by deep feelings of sadness, irritability, hopelessness, and sometimes, thoughts of suicide. It affects the way one feels, thinks, and acts. Often, people who are depressed also have trouble sleeping and concentrating. Depression is defined as an illness when these symptoms persist for two weeks or longer and interfere with a person’s ability to function.

Can children suffer from depression?

Yes. Childhood depression is different from the normal "blues" and everyday emotions that occur as a child develops. Just because a child seems depressed or sad doesn't necessarily mean that he or she has a depressive disorder. When these symptoms last and interfere with social activities, interests, schoolwork, and family life, however, the child may have depression.

Depression is not a passing mood, nor is it a condition that will go away without proper treatment. Keep in mind that while depression is a serious illness, it also is a treatable one.

How can I tell if my child is depressed?

Every child with depression may present with a unique set of symptoms.. Depression is often not diagnosed and treated because the symptoms are passed off as normal emotional and psychological changes that occur during growth. The main symptoms of depression are sadness, a feeling of hopelessness, and mood changes. Parents should speak with their child’s pediatrician if they have any concerns about changes in the child’s mood or behavior.

Signs and symptoms of depression in children include:
  • Irritability or anger
  • Continuous feelings of sadness, hopelessness
  • Withdrawal from friends and family
  • Increased sensitivity to rejection or criticism
  • Changes in appetite (either increased or decreased)
  • Changes in sleep (sleeplessness or too much sleep)
  • Crying or temper tantrums
  • Difficulty concentrating
  • Fatigue (tiredness) and low energy
  • Physical complaints (such as stomach aches, headaches) that do not respond to
    treatment
  • Reduced ability to function during activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests
  • Feelings of worthlessness or guilt
  • Thoughts or talk of death or suicide

Not all depressed children will have all of these symptoms. In fact, most will have different symptoms at different times and in different settings. Although some children may continue to function reasonably well in structured environments, most kids with significant depression will suffer a noticeable change in social activities, loss of interest in school and poor academic performance, or a change in appearance. Experimentation with drugs or alcohol may also be a sign of an underlying mental illness.

Although relatively rare in youths under 12, young children do attempt suicide, and may do so impulsively when they are anxious, angry, or upset. Girls are more likely to attempt suicide, but boys are more likely to actually succeed in killing themselves when attempting suicide. Children with a family history of violence, alcohol abuse, or physical or sexual abuse are at greater risk for suicide, as are those with symptoms of depression. Children are also at risk when they have access to firearms or medications at home.

How common is depression in children?

It is estimated that 2% of children and 4-8% of adolescents in the U.S. suffer from depression. Suicide is the third leading cause of death in older adolescents, and the fifth leading cause of death in children between 5 and 14 years of age.

What causes depression in children?

As in adults, depression in children can be caused by any combination of things, including:

  • physical illness (i.e., diabetes or epilepsy)
  • life events
  • environment (including family problems)
  • family history (others in the family have depression)
  • alcohol or drug use

How is depression in children diagnosed?

If concerning symptoms in your child have lasted for at least two weeks, you should schedule a visit with his or her doctor to make sure there are no physical reasons for the symptoms and to make sure that your child receives proper treatment. The doctor may recommend that your child see a mental health care professional who specializes in treatment of children.

A mental health evaluation should include interviews with you (as the parents) and your child, and if necessary any additional psychological testing. Information from teachers, friends, and classmates can be useful for showing that these symptoms are a definite change from previous behavior.

There are no medical (blood or imaging) or psychological tests that can diagnose depression. Occasionally, tools such as questionnaires for the child and/or parents can help make a diagnosis. Instead, depression is diagnosed via interview by the mental health professional.

How is childhood depression treated?

Treatment options for children with depression are similar to those for adults and include psychotherapy (counseling), medication, or a combination of the two. The severity of symptoms often guides the mental health professional in making a particular recommendation for your child. For example, if symptoms are mild, your child's doctor may suggest psychotherapy first, and consider antidepressant medicine as an additional option if there is no major improvement over the next few months.

Although many antidepressants are routinely used in treating children with depression, the two FDA-approved medications are fluoxetine (Prozac) and escitalopram (Lexapro). Antidepressants must be used with caution, however, as some individuals may have no improvement or feel worse (i.e., more suicidal than when they started taking the medication).

Additional notes about antidepressant medications:
  • Different children can react differently to the same drug.
  • It is important to avoid potentially harmful drug interactions, such as with cold or asthma medications.
  • If the doctor prescribes antidepressant medication for your child, you need to watch the child’s condition closely. Parents should clarify with the physician the goals and limitations that can be expected from a particular medication. Further, parents should be familiar with common and serious potential side effects.
  • No patient should suddenly stop taking antidepressants, because this may cause side effects such as agitation or increased depression.

Since suicidal thoughts often go with depression, guns should be removed from the home and large quantities of medications (including over-the-counter drugs) should be locked away.

What can I expect long-term?

Studies have found that depression in children is occurring at younger ages; in addition, depression and anxiety disorders may occur again later in life. Therefore, proper diagnosis, early treatment, and close monitoring are crucial.

A parent's perspective

As a parent, it is sometimes easier to deny that your child has depression because of the social stigmas associated with mental illness. It is very important that you understand that depression is a biological illness. Treatment of this illness can allow your child to continue to develop into a healthy adult, physically and emotionally. Without treatment, depression has the potential to affect your child throughout the rest of his or her life.

Parents should be especially alert for signs that their child is at risk for suicide. Warning signs of suicidal behavior in children include:
  • Severe depressive symptoms (significant changes in eating, sleeping, activities)
  • Social isolation
  • Talk of suicide, hopelessness, or helplessness
  • Increased acting out behaviors (sexual/behavioral)
  • Increased risk-taking behaviors
  • Frequent accidents
  • Drug and/or alcohol abuse
  • Focus on morbid and negative themes
  • Talk about death and dying
  • Increased crying or reduced expression of emotions
  • Giving away possessions

As with any other medical emergency, if you feel that your child is in danger, take your child to the nearest emergency department or call 911.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/28/2011…#14938