Childhood depression

Emotional fluctuations are normal and expected in children. However, depression in children is a serious issue that goes beyond simply feeling down. If your child experiences long-term depressive symptoms, the time has come to seek help.

Signs that your child might have depression

Symptoms of childhood depression may include persistent feelings of sadness, hopelessness, and a sense of worthlessness.

Other common signs of depression in children include:^[1]

• Irritability
• Inability to focus or concentrate
• Changes in sleeping patterns
• Changes in eating habits
• Loss of enjoyment in once-pleasurable activities
• Changes in energy levels (e.g., feeling persistently sluggish, tired, tense, or restless)
• Feelings of guilt or uselessness

Some children with depression also exhibit self-injurious behaviors (e.g., cutting), self-destructive behavior (e.g., abusing drugs), and might have suicidal ideation.

What causes depression in children?

Just as with adult depression, childhood depression is often the result of a several different causes. Genetics and environmental influences, such as the child’s life experiences, can contribute to the development of depression in children.

These causes are enough to lead to depression on their own, too. For example, children that have one or more depressed parents are more likely to develop depression themselves.^[2] What’s more, children with a depressed caregiver tend to need acute health care services more often, are more likely to have a difficult temperament, and are more likely to have poorer interpersonal functioning.^[3]

As another example, the child’s life experiences can be the primary trigger for the development of childhood depression. Children that have experienced traumatizing events (e.g., survived a natural disaster, abuse, or an act of terror) are nearly four times as likely to develop depressive symptoms.^[3]

Other common risk factors and childhood depression symptoms include:^[2]

• Bullying at school
• Conflict with one’s parents or caregivers
• A romantic breakup
• Maltreatment or neglect
• Low self-esteem
• Rumination about negative life events
• Substance use

Children with comorbid psychological illnesses (e.g., anxiety disorders) or physical illnesses are more likely to experience depression. In addition, some medications can cause depressive symptoms, and children that experience sleep problems are more likely to have depression.

Childhood depression diagnosis

Diagnosing childhood depression requires more than simply observing signs of depression in children. Instead, if you suspect your child has depression, it’s essential to have them evaluated by a mental health professional.

Mental health professionals rely on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as a guide for making a proper diagnosis. The DSM-5 criteria for diagnosing depression are summarized below:^[4]

• One or both of the following must be present: depressed mood or a loss of interest or pleasure in nearly all activities.
• At least four of the following must also be present:n
  • Unintentional weight loss or weight gain of at least five percent in one month or a change in appetite.
  • Sleep disturbances, such as hypersomnia or insomnia.
  • Psychomotor changes, such as motor retardation or agitation.
  • Tiredness, low energy, or fatigue.
  • Feelings of worthlessness or excessive guilt.
  • An impaired ability to think, make decisions, or concentrate.
  • Recurring thoughts of death.
• The symptoms listed above cause clinically significant distress in important areas of functioning.
• The symptoms listed above aren’t better explained by the physiological effects of a substance (e.g., prescribed medication or illicit drugs) or a medical condition (e.g., hyperthyroidism).
• There has never been a manic or hypomanic episode.
• A schizophrenic disorder or another psychotic disorder does not better explain the symptoms listed above.

Mental health professionals have various other instruments to evaluate your child for depression. For example, the Zung Self-Rating Depression Scale, a 20-item self-report questionnaire, is popular for assessing childhood depression, as is the Beck Depression Inventory-II, a 21-item self-report.

In some cases, a mental health professional might use the Patient Health Questionnaire, or PHQ9, which uses nine items to score each of the nine DSM-5 criteria for depression.^[2]

Childhood depression complications

One of the most severe complications of childhood depression is the risk of developing suicidal ideation and self-harm.

Studies indicate that more than 27% of adolescents report thinking about self-harm, while 15% engage in at least one or more acts of self-harm. Of those that harm themselves, 82% report not seeking help for their mental health.^[5]

Self-harming behaviors also lead to other complications. These complications might include the following:

• Childhood depression symptoms that worsen over time
• Experiencing severe depressive episodes
• Developing depressive symptoms that last longer
• The development of another mood disorder
• The development of a comorbid psychiatric condition (e.g., an anxiety disorder, ADHD, conduct disorder)^[6]

How to help your child with depression

Though childhood depression can be severe, the good news is that it is highly treatable. Therapy, medication, and self-help strategies can be used independently or together to treat depressive symptoms. Common treatments are outlined in the sections below.

Therapeutic interventions

Cognitive-behavioral therapy is a well-research option for the treatment for depression in children. CBT focuses on identifying the connections between one’s thoughts and behaviors. CBT also focuses on relearning patterns of thinking as a means of producing healthier outcomes.

Family therapy is another common intervention for childhood depression. As the name indicates, family therapy focuses on the relationship between the child and their caregivers and seeks to foster change by improving interactions among family members.^[1]

Childhood depression also responds well to interpersonal therapy. This type of therapy seeks to help children decrease the interpersonal conflicts they’re experiencing by teaching them improved problem-solving and communication skills, which results in an improved ability to address relationship problems with others.^[2]

Medication

Two antidepressant medications – fluoxetine and escitalopram – are approved for adolescent depression by the Federal Drug Administration (FDA). Sertraline and citalopram are commonly prescribed for this age group as well.

In each case, these antidepressant medications are selective serotonin reuptake inhibitors or SSRIs. This class of antidepressants is generally better tolerated than other antidepressants, with fewer and less severe side effects.^[2]

Nevertheless, the potential for side effects is still present, so working with your child’s doctor to find the medication and dosage that provides the desired effect while minimizing undesirable side effects is essential.

Self-help strategies

Often, children need psychosocial support to cope with their depression. Something as simple as making yourself available to your child to talk can make a difference in their recovery. Other strategies you might try, include the following:^[7]

• Find time to enjoy together. Playing a game, going for a walk, or watching a movie are just a few options.
• Be open with your child about sadness and depression. If applicable, share your experiences with it, and encourage your child to talk to you about their feelings.
• Schedule an appointment with a mental health professional for your child. Go with your child to the appointment butavoid butting in and trying to explain how you think they feel to the therapist. Instead, let your child take the lead.
• Be patient. Your child may lash out at you or blame you for their feelings. Respond to their anger with kindness.
• Encourage your child to eat well, get plenty of rest, and exercise. Joining them in these endeavors will make it easier for them to stick to the plan.

How common is childhood depression?

Depression affects approximately 4.4% of children in the United States. Rates of depression increase with age (e.g., approximately six percent of U.S. children aged 12-17 have depression, while less than two percent of U.S. children between the ages of 6-11 have depression).^[8] 

In Europe, roughly 2.5% of children are believed to have a depressive episode at some point in any given year. However, in the U.S., rates of depression for adolescents are nearly double. ^[9]

On a global scale, it’s estimated that nearly 13% of children and adolescents experience a depressive episode at some point. During the height of the COVID-19 pandemic depression increased, and this number rose to more than 25%. ^[10]