Depression in Children

What is depression in children?

Depression in children is a mood disorder that can cause them to feel sad, irritable or hopeless. Children often have mood swings. They may feel sad or irritable for a period of time, like after getting a bad grade or a falling out with friends. But after a while, they tend to feel better again.

Depression is different. If your child has depression, their sadness hangs on for more than two weeks. They may also have irritability or hopelessness that lingers. It may affect your child’s sleep, appetite or relationships with others. Depression can also prevent your child from enjoying school, sports or hobbies they once enjoyed. In severe cases, depression can lead to thoughts of suicide.

If you notice that your child has symptoms of depression for two weeks or more, talk to their healthcare provider. Although depression is a serious medical condition, it’s usually treatable.

Types of depression in children

• Major depressive disorder. Some people call this clinical depression. It’s the most well-known type of depression in children. If your child has major depressive disorder, they may feel sad or hopeless or anger easily. They may have trouble sleeping, or they may sleep too much. They may not want to do the things that once brought them joy, and they may feel disengaged from their family and friends.
• Premenstrual dysphoric disorder (PMDD). This condition can happen after your child gets their first period. If your child has PMDD, they may have symptoms of depression and/or anxiety that start about a week before they get their period each month. They may anger or cry more easily than usual or have a hard time concentrating. They may seem more irritable the week before their period, and their ability to cope with regular, everyday problems might be impacted (they might really struggle with simple things that otherwise wouldn’t make them worry). They may also have physical symptoms like menstrual cramps, body aches, sore breasts and feeling tired.
• Seasonal affective disorder (SAD). The symptoms of SAD are like those of major depressive disorder, but they come and go with the seasons. It’s common for people to have symptoms during the dark, cold winter months. But it can happen in any season.
• Disruptive mood dysregulation disorder. Children with this condition have frequent angry outbursts or temper tantrums that don’t seem appropriate for their age. They may be physically or verbally aggressive. When a tantrum is happening or your child lashes out at you, it might not feel to you like your child is sad. But it’s always a good idea to let your child’s pediatrician know if you think their behavior doesn’t match their age. Healthcare providers only diagnose this condition in children who are 6 or older.
• Dysthymia. This condition is milder than major depressive disorder. The symptoms are similar, but they last longer. Your child’s symptoms may come and go for years. It might start to feel like the mood changes are just part of your child’s personality. But treatment can help.

How common is depression in children and teens?

About 3% of children and teens between the ages of 3 and 17 have depression. It’s more common in teens than children. About 1 in 5 teens have been diagnosed with major depression. And that’s only those that have an official diagnosis. The actual number is likely much higher. In children and teens with certain chronic illnesses like diabetes, epilepsy, chronic pain and asthma, the rates of depression might be even higher.

What are the symptoms of depression in a child?

Depression in children might look different than it does in adults. And it might look different for each child. Signs and symptoms of depression in a child include:

• Mood changes. Your child might seem sadder or more irritable than usual, and they feel this way most of the time.
• Lack of interest in fun activities.
• Low energy levels or general tiredness.
• Negative self-talk or low self-esteem. You might hear your child say negative things about themselves. They may feel worthless.
• Eating more or less than usual.
• Trouble sleeping or sleeping too much.

What causes depression in children?

Experts don’t know exactly what causes depression in children and adolescents. But they think that genetics and environmental factors play a role. Depression in children is most likely the result of one or more of the following:

• Genetics and family history (other close biological relatives have depression).
• Physical illness or injury.
• Stressful life events like separation, divorce, moving or the death of someone close to them.
• Substance use.
• Bullying or exposure to other traumatic experiences.

What are the risk factors for this condition?

There are many risks that may contribute to childhood depression, including:

• A close family member with depression.
• A history of depression, anxiety disorders, attention-deficit/hyperactivity disorder or conduct issues.
• Adverse childhood experiences.
• Being female.
• Bullying.
• Family conflicts.
• Loss of a loved one or a romantic relationship.
• Medical history, including low birth weight, brain injury or chronic illness (like diabetes).
• Problems with friends.
• Puberty.
• Substance use.

What are the complications of childhood depression?

Children with depression are at increased risk for anxiety and substance use disorders. They may struggle in school. They’re also at higher risk for suicide. Although these symptoms are scary, it’s important to remember that treatments are available. Be sure to follow up with your child’s healthcare provider as often as they recommend. And seek immediate medical attention if you think your child might hurt themselves.

How is depression diagnosed in children?

If you think your child is showing signs of depression, talk to a healthcare provider. Start with your child’s pediatrician. They may refer you to a mental health professional for a more detailed evaluation.

Their healthcare provider will likely start by ruling out conditions that may be causing your child’s mood issues. Illnesses known to cause symptoms of depression include:

• Anemia.
• Chronic pain.
• Concussion.
• Diabetes.
• Epilepsy.
• Hypothyroidism or hyperthyroidism.
• Mononucleosis.
• Vitamin D deficiency.

If your child’s healthcare provider can’t link their mood changes to a physical issue, your pediatrician may refer you to a mental health professional, like a therapist, child psychologist or psychiatrist.

To diagnose depression in your child, their provider will talk with both you and your child. They’ll ask you about your child’s behavior and mood. They’ll ask your child to tell them about any symptoms they notice and when they notice them. They may ask you to complete surveys. They may also want to talk to your child’s teacher or other caregivers for more information about your child’s symptoms.

How is depression treated in children?

There are two main ways to treat depression in children: talk therapy and medication. Both of these treatments may work on their own, but they seem to work better together.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) helps children learn to think more positively about themselves, their past and their future. It can help them manage anxiety and negative behaviors by teaching them coping skills and relaxation techniques.

Medications

The most common antidepressant medications for children are selective serotonin reuptake inhibitors (SSRIs). These medications increase the level of serotonin in your child’s brain. Serotonin is a chemical that can help increase their feelings of happiness and well-being. Common SSRIs that providers prescribe to treat childhood depression include:

• Fluoxetine (Prozac®).
• Paroxetine (Paxil®, Pexeva®).
• Sertraline (Zoloft®).

Side effects of medications that treat depression in children

As with many medications, SSRIs have side effects. Call your healthcare provider if your child develops any of the following side effects:

• Allergic reaction.
• Bloody poop.
• Fast or irregular heartbeat.
• Fainting, dizziness, chest pain or shortness of breath.
• High fever.
• Sudden vision changes or eye pain.
• Thoughts of suicide or worsening mood.

Other side effects of SSRIs don’t normally require medical attention. They should go away after a few weeks but may come back if your child’s dose changes. They may include:

• Appetite changes.
• Difficulty sleeping or drowsiness.
• Dry mouth.
• Headache.
• Shaking (tremors).
• Upset stomach, nausea or diarrhea.

Pay attention when your child starts an antidepressant or when their provider changes the dose. Some kids don’t feel better even with medication. Or they may even feel more depressed. Never allow your child to stop taking antidepressants suddenly. Doing so can cause serious side effects or make depression worse.

How soon after treatment will my child feel better?

Antidepressants can take some time (about four to six weeks) to start working. And not every medication works the same way in every person. Your child’s healthcare provider may try one medication for a while (usually at least several weeks to a few months) to see if it helps relieve their symptoms of depression. If it doesn’t help, they may try a different dose or a different medication. If this is their first episode of depression, psychiatrists recommend staying on the medication for at least nine months.

While there may be some more immediate benefits from counseling, it can take a while for your child to start to trust their therapist. Even after establishing trust, it takes time to change patterns in thinking and behavior.

This may be one reason why many providers prefer to combine medication with therapy for depression. Your child’s therapist can help them learn about their triggers and develop coping skills while the medication takes effect.

Can I prevent my child from developing depression?

You can’t prevent depression in your child. It can develop because of certain situations in life or it may have a biological cause. As a parent, you won’t always be able to manage the stressors in your child’s life, and you can’t do anything about your family history. But you can help improve your child’s mental health by ensuring they get:

• Daily exercise.
• Safe, supportive environment at home and school.
• Plenty of sleep.
• Well-balanced meals.

What can I expect if my child has depression?

If your child has a depressive disorder, they may lose interest in activities they once enjoyed. They may pull away from friends and loved ones. They may be irritable. It might be hard to tell if they’re just acting out or if they have a medical condition. So, as a parent of a child with depression, you can expect to feel a little confused and worried.

Although treatment for childhood depression can take time to work, it generally reduces symptoms. With treatment, many children with depression participate in activities that interest them, form solid friendships and finish school.

There may be periods in your child’s life when their depression starts to overwhelm them again. When this happens, they may need adjustments to their medications or more frequent therapy sessions until they can better manage their symptoms.

How can I help my child with depression?

The most important thing parents and caregivers can do for children with depression — or other mood disorders — is listen to them and support them. When you notice changes in their mood, ask questions. Ask how they’re feeling physically. And ask how they feel about themselves. What they don’t say may be important, too. If your child’s symptoms seem worse after your conversation, you might need a different approach for next time. If — at any time — your child talks about suicide, talk with their mental healthcare provider.

You can also help by tracking:

• How your child sleeps and eats.
• Their energy level and activities.
• Any side effects to medications.
• How they interact with you.
• Participation in hobbies and activities that they normally enjoy.
• Interaction with peers.

It can be hard to remember these details when your child’s healthcare provider asks. If you record these things in a journal, you can take it with you to your child’s appointments. This might help you and your child’s provider identify trends and notice meaningful changes.

When should I call my child’s doctor?

Call a healthcare provider if your child shows signs of depression that don’t go away, if they struggle to fall asleep for more than three days or don’t go to school for more than five days.

If your child shows signs of suicide, get help right away. You can call the Suicide and Crisis Lifeline at 988 (in the United States). This hotline connects you to a national network of local crisis centers for free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, seven days a week. In an emergency, call 911