Introduction
Childhood depression is not the same as the typical “blues” or emotional ups and downs that come with growing up. While a child may feel sad occasionally, persistent sadness or behavior that disrupts daily life—such as affecting their schoolwork, social activities, or family relationships—can signal a more serious problem. It’s important to remember that depression is treatable, and early intervention can help manage the condition.
Overview and Facts
Around 2.5% of children in the U.S. experience depression. Depression is more common in boys than girls before puberty. However, by age 16, girls are more likely to experience depression than boys.
Symptoms
Symptoms of depression in children can vary and are often misunderstood as part of normal emotional growth. Early studies emphasized "masked" depression, where children show depression through acting out or irritability. However, like adults, many children show sadness and low mood. The primary symptoms revolve around feelings of sadness, hopelessness, and mood changes.
Common signs of depression in children include:
Irritability or anger
Persistent sadness or feelings of hopelessness
Social withdrawal and increased sensitivity to rejection
Changes in appetite (either increased or decreased)
Changes in sleep patterns (sleeping too much or too little)
Vocal outbursts or crying
Difficulty concentrating
Fatigue and low energy
Physical complaints (e.g., stomachaches, headaches) that don’t respond to treatment
Reduced ability to function at home, school, or in extracurricular activities
Feelings of worthlessness or guilt
Impaired thinking or concentration
Thoughts of death or suicide
Not all children with depression exhibit every symptom. Most will experience different symptoms at different times, and in various settings. Although some children may still function well in structured environments, significant depression typically leads to noticeable changes in social interactions, academic performance, or appearance. Some children may also begin experimenting with drugs or alcohol, especially after age 12.
Causes and Risk Factors
Depression in children can result from a mix of physical, emotional, genetic, and environmental factors. It is not a passing mood and will not resolve on its own without proper treatment.
Factors that increase the risk of depression include:
Family history of depression: Children with parents who have depression are at higher risk, and they may experience their first depressive episode earlier.
Chaotic or conflicted family environments: Children from unstable or difficult family backgrounds are more prone to depression.
Substance abuse: Teens and children who use alcohol or drugs are at greater risk.
Genetic vulnerability: A child's genetic makeup can also contribute to their likelihood of developing depression.
Tests and Diagnosis
To diagnose depression in children, a doctor will conduct a thorough evaluation. This includes asking about the child’s medical history and ruling out other conditions through physical exams and lab tests (e.g., to check for hypothyroidism or anemia). A mental health assessment may be conducted to evaluate the child’s cognitive abilities, including thinking, reasoning, and memory.
The doctor may ask the parent to complete a pediatric symptom checklist or a brief questionnaire, such as the Children’s Depression Inventory, to help assess depression or other mental health issues. The child may also undergo written or verbal tests to evaluate their symptoms. In some cases, a more detailed assessment may be necessary, which could include interviews with the parents, teachers, or social workers.
Treatment
Treatment for childhood depression is similar to that for adults, with both psychotherapy and medication being common options. However, family involvement and the child’s environment play a key role in the treatment process. Typically, a doctor may recommend starting with psychotherapy and only consider medication if significant improvement does not occur.
The most effective treatment, based on current research, often involves a combination of psychotherapy and medication. This approach helps address both the emotional and biological aspects of the disorder.
Sources and Links
www.aacap.org
www.depressedchild.org