What to Know About Childhood Depression

Although most people think of depression as an adult illness, children and adolescents can develop depression as well. Unfortunately, many children with depression go untreated because adults don't recognize they're depressed.  

It's important for parents, teachers, and other adults to learn about childhood depression. When you understand the symptoms of depression in children and the reasons children develop it, you can intervene in a helpful manner.

How Children Experience Depression

According to the American Academy of Child and Adolescent Psychiatry, common signs of depression in children and teens last longer than two weeks and may manifest similar symptoms to adults, such as:

• Changes in appetite or weight
• Feeling or appearing depressed, sad, tearful, or irritable
• Fatigue or perceived lack of energy 
• Feeling guilty or ashamed  
• Having more trouble concentrating
• Loss of interest or pleasure in previously enjoyed activities
• Psychomotor slowing or agitation
• Sleep disturbance: Insomnia or hypersomnia nearly every day
• Thoughts of suicide and/or death 

Depression in children and teens usually presents differently than it does in adults. Young children often find it difficult to explain their feelings and may regress to earlier behaviors such as thumb-sucking or bed-wetting. They may have more nightmares and difficulty sleeping.

Irritability and/or anger are more common signs of depression in older children and teens. They may not want to spend time with their friends or participate in their usual activities. They may complain of stomach aches, headaches, and not feeling well to avoid going to school. Teens may attempt to hide their emotional pain, fearing judgment from others. 

In addition to the above symptoms, some children will begin to have poor school performance, troubled peer relationships, and possibly substance abuse.

Because normal behaviors vary as children develop, it can be challenging to know if your child is going through a phase or if it’s something more serious. The first step towards helping your child battle depression is learning how to spot it.

Causes of Childhood Depression

While stressful life events, like divorce, may contribute to depression, it's only a small piece of the puzzle. Many other factors, including genetics, differences in neurological or physical development, major illness, and other psychosocial factors, also play a role in its onset. 

There are a number of different factors that can contribute to childhood depression, including:

• Family history: Genetics play a significant role in creating a predisposition for mood disorders. Children with family members who also have mood disorders such as depression are at a greater risk of experiencing these symptoms as well.
• Brain chemistry: Imbalances in certain neurotransmitters and hormones may play a role in how the brain works, which can affect moods and emotions and increase the risk of experiencing depression. Early puberty and hormone changes can also be a trigger for the onset of depressive symptoms.
• Environmental factors: A stressful, chaotic, or unstable home environment can also make children more likely to experience depression. Rejection and bullying at school may also be contributing factors.
• Stress or trauma: Sudden changes such as moving, divorce, or traumatic events such as abuse, natural disasters, and war can also contribute to feelings of depression.
• Self-concept issues: Not having enough exposure to activities that help them develop their personalities, talents, and skills may contribute to low self-esteem, poor self-efficacy, and thwarted social identity development.

Anyone can develop depression, and it isn't a sign of weakness. It also isn't your fault if your child is depressed. However, there may be some things you can do to help.

Diagnosing Childhood Depression

If you think your child is showing signs of depression, schedule an appointment with your child's pediatrician to discuss your concerns.

Before arriving at a diagnosis, your child should undergo a comprehensive physical evaluation. This will rule out any underlying medical conditions that could be contributing to the symptoms you are seeing. For example, thyroid problems, anemia, and vitamin deficiency can all mimic symptoms of depression.

While there is no specific test for depression, a doctor may use one or multiple psychological assessments to further evaluate the type and severity of depression your child is experiencing.

Classification of Depression

When your child is diagnosed with a depressive disorder, it is typically classified by severity:

• Mild
• Moderate
• Severe (also called "major" or "clinical" depression)

According to the DSM-5-TR, this classification is based on the number, type, and severity of symptoms and the degree to which they interfere with your day-to-day life.

Depression Treatment

If your child is diagnosed with mild depression, their doctor will actively monitor their symptoms before recommending any form of treatment. If their symptoms persist after 6 to 8 weeks of support, they will be referred for psychotherapy. If your child is initially diagnosed with moderate to severe depression, their doctor will likely skip this step and start treatment immediately. 

Psychotherapy, medications, or a combination of the two have been shown to help young people with depression. The kind of treatment recommended for your child will depend on the nature and severity of their depression. 

Psychotherapy

If your child is diagnosed with mild depression, the APA recommends psychotherapy as a first-line treatment. For adolescents with moderate to severe depression, research has shown that a combination of psychotherapy and medication works best. 

In psychotherapy, a mental health professional will help your child develop the skills needed to manage their depressive symptoms so they can function well both at home and in school. Two kinds of psychotherapy are recognized as the treatment of choice for children with depression:

• Cognitive behavioral therapy (CBT): Helps improve a child's mood by identifying negative thought and behavior patterns and replacing them with positive ones.
• Interpersonal therapy (IPT): An approach in which therapists help adolescents learn how to handle relationship problems that may be contributing to or resulting from their depression.

Depending on the situation, other forms of therapy may be needed, such as play therapy, family therapy, or trauma-focused therapy.

Medications

Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line antidepressant option for young people with depression. Only two SSRIs—Prozac (fluoxetine) and Lexapro (escitalopram)—are FDA-approved for use in young people with depression.

Their doctor may also prescribe a different SSRI or a serotonin-norepinephrine reuptake inhibitor (SNRI) if they think it is in your child's best interest. This is referred to as off-label use, and it is a fairly common practice.

Coping

For mild cases of depression, lifestyle changes can often be an effective way to address feelings of depression. Things like finding ways to manage stress, getting regular physical exercise, using relaxation techniques, developing new hobbies and interests, and building a stronger social support system can help improve how a child feels.

The following are some proactive steps you can take to encourage healthy coping skills and support mental health:

• Talk about how caring for the body also helps the mind. Explain how eating nutritious food and getting plenty of exercise is good for their mental health. Make staying health a priority for the whole family.
• Make sure your child has a consistent sleep schedule. Turn off devices before bedtime, and make sure your child goes to bed and wakes up at the same time each day.
• Help your child develop a rich social life without over-scheduling their time. Assign responsibilities and reward them when they follow through. 
• Teach your child how to identify their feelings and their needs and how to manage their emotions in healthy ways. Help them solve problems and develop strategies for coping with failure and setbacks.
• Talk about your mental health, too, at an age-appropriate level. That way, they know you are relatable and will be more comfortable talking about their own feelings.
• Make sure your child knows you will listen to them when they need to talk about their feelings and find a consistent source of emotional support in you.

Ultimately, it's up to the guardians to decide what treatment options to employ. It's important for parents and children to educate themselves about treatment and the potential risks and benefits of each option. 

Final Thoughts

Childhood depression can have a serious impact on a child's life, so it is always important to be on the lookout for warning signs that your child may be depressed. Talk to your child about their feelings, and be careful to remain supportive and non-judgmental.

Thankfully, early interventions can help kids get back on track before symptoms of depression take a serious toll on their lives and ability to function.