Depression in Children: Symptoms, Diagnosis, and Treatment

Depression is not just a problem experienced by adults; children can also suffer from it. Depression in children may be dismissed as “growing pains”, but it is different from everyday childhood emotions. Naturally, children experience mood swings as they are growing and developing, but when the feelings of sadness persist to the point of interfering with normal activities, schoolwork, and family life, it may indicate depression.

Depression is more likely to be experienced by older children and teenagers, but it can affect younger children too. It is estimated that 13.3% of the U.S. population between the ages of 12 and 17 have had at least one major episode of depression. If you have any concerns about your child, talk to a healthcare provider.

How can I tell if my child is depressed?

The symptoms for depression vary and may often be passed off as normal emotional, and psychological changes associated with growing up. The primary symptoms tend to be feelings of sadness and hopelessness, and mood swings. Studies have focused on “masked” depression in children, evidenced by acting out and angry behavior, and this does occur. However, often the symptoms are like those experienced by adults.

Symptoms may include changes in eating habits, with a loss of appetite or binge eating, or changes in sleeping habits, either sleeping much more than usual or staying awake more than usual. Depressed children may experience fatigue or low energy and tiredness, feel sluggish, or alternately feel tense and restless a lot of the time.

There may be frequent mood changes, and they may experience feelings of sadness and hopelessness, worthlessness, and guilt, along with physical complaints, like headaches or stomach aches that do not respond to treatment.

Other symptoms include behavioral changes, including problems at school, social withdrawal, irritability or anger, and a lack of interest in activities that were previously considered to be fun. A depressed child could become increasingly sensitive to rejection and be prone to angry outbursts and crying.

They may have difficulty concentrating, thinking, and paying attention and experience a reduced ability to function during events or activities at home, school, or with friends. They may have thoughts of death and suicide and may even show signs of self-injury or self-destructive behavior.

Some children will not talk about their hopeless thoughts, but they may act out and cause trouble, sometimes being mistakenly labeled as troublemakers. Others may become unmotivated and be mistakenly labeled as lazy.

Different symptoms may be displayed at various times. Some children may even continue to function reasonably well in structured environments, like at school. But in most cases, you will notice a change in social activities, a loss of interest in school, and poor academic performance. Older children may even begin to use substances like alcohol and drugs.

Causes of depression in children

Depression can result from any combination of factors related to health, life events, family history, genetics, or a biochemical disturbance. It is more than just a passing mood or condition that will go away without proper treatment. Having a family with a history of depression may increase the likelihood of a child suffering from depression.

Children who have parents who struggle with depression tend to experience their first episode of depression earlier than those who do not. Families that experience conflict or chaotic lifestyles, as well as families with a history of alcohol or substance abuse, are at increased risk. Alcohol and drug use, physical illness, or stressful life events like family problems or trauma, can all contribute to the likelihood of experiencing depression.

How is depression diagnosed in children?

If the symptoms you notice in your child persist for a least two weeks, your first step should be to see your primary healthcare provider or a mental health specialist. Your doctor should be able to rule out any physical reasons for the symptoms, such as illnesses like anemia, concussion, diabetes, epilepsy, hypothyroidism or hyperthyroidism, mononucleosis, or vitamin D deficiency – all known to produce depression-like symptoms.

If your doctor decides that it is depression, they will be able to recommend a proper course of treatment for your child. At this stage, they may recommend meeting with a mental health professional. Be aware, however, that your pediatrician may wish to speak to your child alone.

Your child will need to be evaluated by their doctor or mental health specialist. Some symptoms may be caused by other conditions, such as trauma, ADHD, or bipolar disorder, which is why it is important to get a careful evaluation for the best diagnosis and treatment.

A mental health evaluation will include interviews with the child as well as with the parent or caregiver of the child. It may also include additional psychological testing that the mental health professional considers necessary. Any other information from other people, like teachers, who can attest to any marked changes in the child’s behavior and the consistency of the symptoms in different environments, will also be helpful.

There is no specific test for diagnosing depression but testing often involves a questionnaire and the collection of personal information. Sometimes therapy can unearth other concerns that may contribute to depression, like ADHD, and OCD. Some pediatricians will begin to give children mental health screenings annually from the age of eleven onwards.

Treatment options

Treatments for children with depression are similar to those for adults. It is usually treated with psychotherapy, medication, or a combination of the two. Your healthcare provider can decide if antidepressant medications are necessary and you may wish to try counseling first, allowing the doctor to suggest the possibility of medication should there be no meaningful change with psychotherapy.

A combination is usually most effective. Counseling can include one-on-one therapy with your child, family therapy, or a combination of both. Your mental health professional can help you to come up with the best treatment plan for your child and family.

For very young children, involving the parents in the treatment is key. Older children may use Cognitive Behavior Therapy (CBT) to help them replace negative thinking with more positive and effective ways of thinking, resulting in more positive changes in behavior.

Treatment plans may also include learning ways of dealing with stress and health improvement through eating nutritious food, exercise, getting enough sleep, creating helpful routines, and getting social support.

Selective Serotonin Reuptake Inhibitors (SSRIs) are the most prescribed medications for children. Serotonin is a chemical in the brain that can help increase feelings of happiness and wellbeing, and SSRIs increase the level of serotonin in the brain.

One should always be extra cautious when using antidepressants with children. Some children show no improvement or may even feel more depressed, so you need to monitor your child’s condition closely, especially in the early days of using a new medication or dosage. You should never allow a child to suddenly stop taking antidepressants because this can result in serious side effects or even make their depression worse.

The Food and Drug Administration (FDA) also issues the warning that there is an increased risk of suicidal thinking and behavior in children and adolescents suffering from depression and psychiatric disorders when they start taking antidepressants or change the dosage of their antidepressants.

In the long-term, antidepressants will decrease a child’s risk of suicide by improving their mood, but since they may take a while to take effect, you need to watch your child carefully in the beginning.

Should I worry about suicide?

Nine percent of high school students attempted suicide at least once in 2019. Although it is less common in younger children, it is not unheard of and while children under the age of twelve rarely attempt it, they may do so impulsively when they are angry.

Girls are more likely to attempt suicide, while boys are more likely to succeed at killing themselves when they do attempt it. There is an increased risk of suicide where there is a family history of violence, physical or sexual abuse, or alcohol abuse, as well as among those with symptoms of depression.

You ought to watch carefully for warning signs, such as a focus on death and dying, talk of suicide or hopelessness, social isolation, increased risk-taking, self-destructive behavior or self-harm, and giving away of possessions.

Depression is occurring at younger ages than ever before. When a person experiences depression as a child, it may occur again later as an adult. Because depression may precede more serious mental illnesses later in life, early diagnosis, treatment, and monitoring are crucial.

As a parent, it may be tempting to deny obvious symptoms and put off seeking mental health care because of fears or social stigmas. However, it is important to understand depression and get it treated so that your child can continue to grow in a healthy way.