Depression in Children and Adolescents

Just like adults, children and adolescents can go through periods of low mood, sadness, or irritability. Most of the time, these feelings are a normal part of growing up and aren't cause for concern. But sometimes these feelings become intense enough to affect a child's life at home, at school, or with friends. When that happens, it may be a sign of something more — clinical depression, formally known as major depressive disorder (MDD). While the diagnosis has the same name across all ages, depression can look quite different in children and teens than it does in adults.

What Is Major Depressive Disorder?

Depression is one of the most common mental health conditions in the world, affecting roughly 1 in 5 people at some point in their lives (Weersing et al., 2017; Forti-Buratti et al., 2016). To be diagnosed with MDD, a person must experience symptoms for most of the day, nearly every day, for at least two weeks (American Psychiatric Association [APA], 2022). At least one of those symptoms must be either a depressed mood or a loss of interest or pleasure in activities a person once enjoyed (APA, 2022).

Other symptoms can include:

•       Fatigue or low energy

•       Thoughts of death or suicide

•       Trouble concentrating or making decisions

•       Noticeable changes in physical movement (moving more slowly or more restlessly than usual)

•       Sleeping too much or too little

•       Feelings of guilt or worthlessness

•       Significant, unintended weight loss or gain

(APA, 2022)

The diagnostic criteria are largely the same for children, adolescents, and adults, with a couple of important differences. In children and teens, a depressed mood often shows up as irritability rather than sadness (APA, 2022). And instead of losing weight, a child may simply fail to gain the weight expected for their age and growth (APA, 2022).

If you notice these signs in your child or teen, it's worth knowing that effective treatment is available.

Depression in Children and Adolescents

Depression is less common in younger children, affecting an estimated 1–2% of children before adolescence (Forti-Buratti et al., 2016). But even though it's less frequent at this age, children who experience depression are more likely to develop other mental health conditions later in life (Forti-Buratti et al., 2016). Depression in childhood is also linked to greater difficulty with schoolwork, friendships, and family relationships (Forti-Buratti et al., 2016).

As children move into their teenage years, rates of depression rise — by the mid-teens, the likelihood of experiencing depression is similar to what's seen in adults (Forti-Buratti et al., 2016). Some factors that increase the likelihood of adolescent depression include a parent's history of depression, being female, going through stressful life events, and having difficulty managing emotions (Hammen et al., 2008). Research also shows that when a parent has depression, their adolescent is more likely to experience repeated depressive episodes (Hammen et al., 2008). Because earlier-onset depression tends to come back and can affect a young person's functioning in multiple areas of life, catching it early and treating it effectively matters (Weersing et al., 2017).

Treatment Options

A number of therapy approaches can help children and adolescents with depression. Research on the most effective treatments for younger children is still evolving (Forti-Buratti et al., 2016), but because depression in youth can shape long-term functioning and quality of life, getting evidence-based treatment early on is important (Dippel et al., 2022).

Cognitive behavioral therapy (CBT) is one of the most well-researched and well-supported treatments for depression. The evidence for CBT is strong for adolescents, and somewhat more mixed — though still encouraging — for younger children (Weersing et al., 2017). One review of multiple studies found that CBT was more effective than no treatment at all for children with depression (Yang et al., 2017). Overall, CBT remains a solid, effective option for treating depression in both children and adolescents.

Family involvement is often part of treatment. Research shows that including caregivers and family members in therapy can improve outcomes for adolescents in general, and for depression specifically (Dippel et al., 2022). If you're a caregiver, it's worth talking with your child's therapist about whether family involvement makes sense for your situation.

How Do I Know If This Is Normal Behavior or Depression?

As mentioned above, depression in children and teens can look different than it does in adults — irritability, rather than sadness, is often the bigger clue. It also helps to remember that as kids grow, especially during adolescence, they naturally shift from being parent-focused to peer-focused. Mood swings and a growing need for privacy and independence are typical parts of this stage.

That can make it genuinely hard to tell whether your child is going through normal ups and downs or something more serious. Some signs worth paying closer attention to include:

•       A noticeable decline in school performance

•       Withdrawing from friends or family

•       Losing interest in activities they used to enjoy

•       Any talk of self-harm or wanting to hurt themselves

A formal diagnosis needs to come from a trained professional, but you don't have to figure this out alone. If you're concerned, it's a good idea to talk to your child's pediatrician or reach out to a therapist for an assessment.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Dippel, N., Szota, K., Cuijpers, P., Christiansen, H., & Brakemeier, E. L. (2022). Family involvement in psychotherapy for depression in children and adolescents: Systematic review and meta-analysis. Psychology and Psychotherapy, 95(3), 656–679. https://doi.org/10.1111/papt.12392

Forti-Buratti, M. A., Saikia, R., Wilkinson, E. L., & Ramchandani, P. G. (2016). Psychological treatments for depression in pre-adolescent children (12 years and younger): Systematic review and meta-analysis of randomised controlled trials. European Child & Adolescent Psychiatry, 25(10), 1045–1054. https://doi.org/10.1007/s00787-016-0834-5

Hammen, C., Brennan, P. A., & Keenan-Miller, D. (2008). Patterns of adolescent depression to age 20: The role of maternal depression and youth interpersonal dysfunction. Journal of Abnormal Child Psychology, 36, 1189–1198. https://doi.org/10.1007/s10802-008-9241-9

Weersing, V. R., Jeffreys, M., Do, M. T., Schwartz, K. T., & Bolano, C. (2017). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child and Adolescent Psychology, 46(1), 11–43. https://doi.org/10.1080/15374416.2016.1220310

Yang, L., Zhou, X., Zhou, C., Zhang, Y., Pu, J., Liu, L., Gong, X., & Xie, P. (2017). Efficacy and acceptability of cognitive behavioral therapy for depression in children: A systematic review and meta-analysis. Academic Pediatrics, 17(1), 9–16. https://doi.org/10.1016/j.acap.2016.08.002