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This topic covers depression in children and teens.
For information about depression in adults, see the topic
Depression. For information about depression with
episodes of high energy (mania), see the topic
Bipolar Disorder in Children and Teens.
Depression is a serious mood disorder that can take the joy from a
child's life. It is normal for a child to be moody or sad from time to time.
You can expect these feelings after the death of a pet or a move to a new city.
But if these feelings last for weeks or months, they may be a sign of
Experts used to think that only adults could get
depression. Now we know that even a young child can have depression that needs
treatment to improve. As many as 2 out of 100 young children and 8 out of 100 teens
have serious depression.footnote 1
children don't get the treatment they need. This is partly because it can be
hard to tell the difference between depression and normal moodiness. Also,
depression may not look the same in a child as in an adult.
you are worried about your child, learn more about the symptoms in children.
Talk to your child to see how he or she is feeling. If you think your child is
depressed, talk to your doctor or a counselor. The sooner a child gets
treatment, the sooner he or she will start to feel better.
A child may be depressed if
he or she:
A child who is depressed may also:
The symptoms of depression are often overlooked at first.
It can be hard to see that symptoms are all part of the same problem.
Also, the symptoms may be different depending on how old the child is.
Depression can range from mild to severe. A child who
feels a little "down" most of the time for a year or more may have a milder,
ongoing form of depression called
dysthymia (say "dis-THY-mee-uh"). In its most severe
form, depression can cause a child to lose hope and want to die.
Whether depression is mild or severe, there are treatments that can help.
Just what causes
depression is not well understood. But it is linked to a problem with activity levels in certain parts of the brain as well as an imbalance of
brain chemicals that affect mood. Things that may
cause these problems include:
depression, a doctor may do a physical exam and ask questions about your child's
past health. You and your child may be asked to fill out a form about your child's symptoms.
The doctor may ask your child questions to learn more about how he or she
thinks, acts, and feels.
Some diseases can cause symptoms that
look like depression. So the child may have tests to help rule out physical
problems, such as a
low thyroid level or
It is common for children with
depression to have other problems too, such as
attention deficit hyperactivity disorder (ADHD), or an
eating disorder. The doctor may ask questions about
these problems to help your child get the right diagnosis and treatment.
Usually one of the first steps
in treating depression is education for the child and his or her family.
Teaching both the child and the family about depression can be a big help. It
makes them less likely to blame themselves for the problem. Sometimes it can
help other family members see that they are also depressed.
Counseling may help the child feel better. The type of
counseling will depend on the age of the child. For young children,
play therapy may be best. Older children and teens may
cognitive-behavioral therapy. This type of counseling
can help them change negative thoughts that make them feel bad.
Medicine may be an option if the child is very depressed. Combining
antidepressant medicine with counseling often works best. A child with severe
depression may need to be treated in the hospital.
There are some
things you can do at home to help your child start to feel better.
Antidepressant medicines often work well for children who are depressed. But there are some important things you should know about these medicines.
Learning about depression in children and teens:
Living with depression in children and teens:
Health Tools help you make wise health decisions or take action to improve your health.
thought to be caused by an imbalance of chemicals called
neurotransmitters that send messages between nerve
cells in your brain. Some of these chemicals, such as serotonin, help regulate
mood. If these mood-influencing chemicals get out of balance, depression or
other mood disorders can result. Experts have not yet identified why
neurotransmitters become imbalanced. They believe a change can occur as a
response to stress or illness. But a change may also occur with no obvious
There are several things known to increase the chances
that a young person may become depressed.
The symptoms of depression are often subtle at first. They may occur suddenly or happen slowly over time. It can be hard to
recognize that symptoms may be connected and that your child might have
It's important to watch for
warning signs of suicide in your child or teen. These
signs may change with age. Warning signs of suicide in children and teens may
include preoccupation with death or suicide or a recent breakup of a
Depression can have symptoms that are similar to those caused by
depressed children may also have other symptoms, such as:
the difference between normal moodiness and symptoms of depression can be
hard. Occasional feelings of sadness or irritability are normal. They
allow the child to process grief or cope with the challenges of life.
example, grieving (bereavement) is a normal response to loss, such as the
death of a family member or even the death a pet, loss of a friendship, or
parents' divorce. After a severe loss, a child may remain sad for a longer
period of time.
But when these emotions do not go away or begin to interfere
with the young person's life, he or she may need treatment.
Some children who are first diagnosed with
depression are later diagnosed with bipolar disorder. Children or teens with
bipolar disorder have extreme mood swings between depression and bouts of
mania (very high energy, agitation, or irritability).
It can be hard to tell the difference
bipolar disorder and depression. It is common for
children with bipolar disorder to first be diagnosed with only depression and
later to be diagnosed with bipolar disorder after a first manic episode.
Although depression is part of the condition, bipolar disorder requires
different treatment than depression alone.
Like depression, bipolar disorder
runs in families. So be sure to tell your doctor if your child has a family
history of bipolar disorder. For more information on bipolar disorder, see the
topic Bipolar Disorder in Children and Teens.
At first, depression in a
child or teen may appear as irritability, sadness, or sudden, unexplained
crying. He or she may lose interest in activities enjoyed in the past or may
feel unloved and hopeless. He or she may have problems in school and become
withdrawn or defiant.
An episode of depression lasts an average of 8 months.footnote 1 Even with successful treatment, as many as 40 out of 100 children
with depression will have another episode within a few years.footnote 2
Less than half of children and teens with depression receive treatment.footnote 3 This may be partly due to the old belief that young people don't get depression.
Also, teens often do not seek help for depression. They may think feeling bad is normal, or they may blame something else (or themselves) for their symptoms. Or they may not know where to go for help. Tell your child to ask for help if he or she feels bad. And let your child know who to go to for help with depression or other problems.
Some teens will
alcohol or drug use problems along with
depression. When this happens, depression is harder to treat, and it can take longer for treatment to work. Drug or alcohol use also increases the risk of suicide.
Early diagnosis and treatment of
depression and good communication with your child can help prevent substance
use. For more information about substance use in young people, see the
Teen Alcohol and Drug Use.
Often a child who is depressed will have
other disorders along with depression, such as an
anxiety disorder, a behavior disorder like
attention deficit hyperactivity disorder (ADHD), an
eating disorder, or a learning disorder.
problems may occur before a young person becomes depressed. Some children with
depression develop serious behavior problems (conduct disorder), often after becoming depressed. If your child has one of
these disorders, it may require treatment along with depression.
and teens with depression are also at a higher risk for problems
For severe depression, your child may need to be
hospitalized, especially if he or she is out of touch with reality (psychotic) or is having thoughts of suicide.
During treatment for depression, make sure that your child
takes medicines and attends counseling appointments as directed, even if he or
she feels better. A common cause of
relapse is stopping treatment too soon.
It's very important to recognize the warning signs of suicide in your child or teen. Carefully watch for signs of suicidal behavior
if your child has recently:
It is extremely important that you take all threats of suicide seriously and seek immediate treatment for your child or teenager. If you are a child or teen and have these feelings, talk with your parents, an adult friend, or your doctor right away to get some help. If your child is suicidal, call 911 or other emergency services immediately.
Several things increase a
young person's chance of developing
depression. These include:
Other risk factors for depression include:
Call 911, the national suicide hotline at 1-800-273-TALK (1-800-273-8255), or other emergency services right away if:
Call a doctor right away if:
Seek care soon if:
depression may involve professional
counseling, medicines, education about depression for
your child and your family, or a combination of these. It is important that
your child establish a long-term and comfortable relationship with the care
providers for the treatment of depression.
Your child may be
diagnosed and treated by more than one health professional, including a:
counseling (or psychotherapy) for depression can be
provided by a:
Other health professionals who also may be trained in
counseling include a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor or another health
professional will evaluate and diagnose
depression in your child by asking questions about
your child's medical history and conducting tests to find out if symptoms are
caused by something other than depression. Your child may be given a physical
exam or blood tests to rule out conditions such as
anemia. Your child may be asked to complete a
mental health assessment, which tests his or her
ability to think, reason, and remember.
You may be asked to help
complete a pediatric symptom checklist, a brief screening questionnaire that
helps to diagnose depression or other psychological problems in children. Also,
your child may be asked to take a short written or verbal test for depression.
Sometimes a more thorough evaluation may be needed to fully
assess your child's depression. Interviews may be conducted with the parents or
with other people who know the young person well. Specific information may be
obtained from the child's teachers or from social service workers.
The U.S. Preventive Services Task Force recommends screening for
depression in all children ages 12 to 18.
sooner treatment begins for depression, the sooner your child is likely
to recover. Waiting to seek treatment for depression may mean a longer and
more difficult recovery.
Treatment typically includes professional
counseling, medicines, and education about depression
for your child and your family.
Home treatment is an important
part of treating depression. It includes regular exercise, healthy eating, and getting enough sleep.
Professional counseling for depression includes several types of therapy, such as cognitive-behavioral therapy and family therapy. For more information about counseling, see Other Treatment.
Medicines used to treat childhood
depression include several types of drugs called antidepressants.
An important part of treatment is making
sure that your child takes medicines as prescribed. Often people who feel better
after taking an antidepressant for a period of time may feel like they are
"cured" and no longer need treatment. But when medicine is stopped too early, symptoms
usually return. So it is important that your child follows the treatment
The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. Talk to your doctor about these possible side effects and the warning signs of suicide
Before prescribing medicine, your doctor will check your child for possible suicidal
thoughts by asking a few questions. See a list of
questions your doctor may ask your child.
Education of your child and family members can be provided by
a doctor either informally or in family therapy. Some of the most important
things that your child and family members can learn include:
Your child may need treatment for other disorders that may be causing ongoing symptoms, such as:
A brief hospital stay may be needed, especially if your
your child is depressed, consider removing all guns and potentially fatal
medicines from your home, especially if your child has shown any warning signs
of suicide. Although overdosing on medicine is the most common way that teens
attempt suicide, your child is at higher risk for dying by suicide if you
have a gun in your home, particularly if it is easy to get to it or if you
store it loaded.footnote 5
It is difficult to prevent a first episode
depression. But it may be possible to prevent or
reduce the severity of future episodes of depression (relapses).
Do everything possible to provide a supportive family environment. Love,
understanding, and regular communication are some of the most important things
you can provide to help your child cope with
In addition to having a
positive home life, staying in professional counseling, and taking medicines as
prescribed, good lifestyle habits can help reduce your child's symptoms of
depression. Encourage your child to:
If you notice any
warning signs of suicide (such as aggressive or
hostile behavior, excessive thoughts about death, or detachment from reality),
seek professional help immediately by calling either your child's doctor, a
professional counselor, or a local mental health or emergency service. Create a plan to help keep your child safe. Lock away knives and other sharp objects, firearms, poisons, and medications. Call 911 if you feel your child is in immediate danger.
Although experts believe that, for many children with depression, the benefits of medicine outweigh the risks, research on antidepressant medicine in children is limited. The long-term effects and safety of medicines used to treat depression in children and teens are still unknown.
You may have heard about concerns regarding a possible connection between antidepressant medicines and suicidal behavior. The U.S. Food and Drug Administration (FDA) has issued advisories about this issue.
Especially during the
first few weeks of treatment with an antidepressant, there is a possible
increase in suicidal feelings or behavior. A child beginning antidepressant
treatment should be watched closely. But children with untreated depression
are also at an increased risk for suicide. So it is important to carefully
weigh all of the risks and benefits of antidepressant medicine.
Antidepressant medicines include:
Antidepressant medicines such as
fluoxetine (Prozac, for example) can be effective in treating depression, but
it may take 1 to 3 weeks before your child starts to feel better. It can take
as many as 6 to 8 weeks to see more improvement. Make sure your child takes
antidepressant medicines as prescribed and keeps taking them so they have time
to work. If you have any questions or concerns about the medicine, or if you do
not notice any improvement by 3 weeks, talk to your child's doctor.
Some antidepressants may also be effective in treating other conditions such as
Your child may have to try
several medicines or different dosages before the most effective treatment is discovered. After the
right medicine and dosage is found, your child may need to continue taking the medicine
for several months or longer after the symptoms of depression have subsided, to
prevent depression from occurring again.
Some children who are
first diagnosed with depression are later diagnosed with
bipolar disorder, which has symptoms that cycle from
mania (very high energy, often with euphoria,
agitation, irritability, risk-taking behavior, or impulsiveness). If your child
or teen has bipolar disorder, a first episode of mania can happen
spontaneously. But it can also be triggered by certain medicines such as
stimulants or antidepressants. That is why it is very important to tell your
child's doctor about any family history of bipolar disorder and to watch your
child closely for signs of manic behavior. For more information about bipolar
disorder in young people, see the topic
Bipolar Disorder in Children and Teens.
The U.S. Food and
Drug Administration (FDA) has issued an
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for
warning signs of suicide. These signs may include talking about death or suicide and giving away belongings. This is especially important at the beginning of treatment or when doses are changed.
Besides taking medicine, other treatment for depression includes professional counseling and electroconvulsive therapy.
Complementary medicine is sometimes used for
depression in adults. But there is
no evidence that these therapies are safe for use by children or teens.footnote 2 They can interfere with other
medicines, such as antidepressants. Always tell your doctor if you are using any complementary therapies.
The U.S. Food and Drug
Administration (FDA) has approved the vagus nerve stimulator (VNS) implant for
treatment of depression in adults. This device may be used when other
treatments for depression have not worked.
A generator the size
of a pocket watch is placed in the chest. Wires go up the neck from the
generator to the vagus nerve. The generator sends tiny electric shocks through
the vagus nerve to that part of the brain that is believed to play a role in
More study is needed to see how well this works in children who have depression.
CitationsWagner KD, Brent DA (2009). Depressive disorders and suicide. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3652-3663. Philadelphia: Lippincott Williams and Wilkins.Hazell P (2011). Depression in children and adolescents, search date July 2011. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.Substance Abuse and Mental Health Services Administration (2009). Major depressive episode and treatment among adolescents. National Survey on Drug Use and Health (NSDUH) Report. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available online: http://oas.samhsa.gov/2k9/youthDepression/MDEandTXTforADOL.htm.Vanderbilt D, Augustyn M (2011). Bullying and school violence. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., online chap. 36.1. Philadelphia: Saunders Elsevier. Available online: http://www.expertconsult.com.Dulcan MK, et al. (2012). Special clinical circumstances. In Concise Guide to Child and Adolescent Psychiatry, 4th ed., pp. 209-254. Washington, DC: American Psychiatric Publishing.Garber J, et al. (2009). Prevention of depression in at-risk adolescents: A randomized controlled trial. JAMA, 301(21): 2215-2224.Other Works ConsultedAmerican Psychiatric Association (2013). Depressive disorders. In Diagnostic and Statistical Manual of Mental Disorders, 5th ed., pp.155-188. Washington, DC: American Psychiatric Association.Brent DA, Wheersing VR (2007). Depressive disorders. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 503-513. Philadelphia: Lippincott Williams and Wilkins.March JS, et al. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) Randomized Controlled Trial. JAMA, 292(7): 807-820.Mrazek DA, Mrazek PJ (2007). Prevention of depression and suicide in children and adolescents. In A Martin, FR Volkmar, eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp. 171-177. Philadelphia: Lippincott Williams and Wilkins.Sass A, et al. (2014). Adolescence. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 22nd ed., pp. 117-157. New York: McGraw-Hill.Wagner KD, Brent DA (2009). Depressive disorders and suicide. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3652-3663. Philadelphia: Lippincott Williams and Wilkins.
ByHealthwise StaffPrimary Medical ReviewerJohn Pope, MD - PediatricsKathleen Romito, MD - Family MedicineChristine R. Maldonado, PhD - Behavioral HealthSpecialist Medical ReviewerDavid A. Brent, MD - Child and Adolescent Psychiatry
Current as ofMay 16, 2017
Current as of:
May 16, 2017
John Pope, MD - Pediatrics & Kathleen Romito, MD - Family Medicine & Christine R. Maldonado, PhD - Behavioral Health & David A. Brent, MD - Child and Adolescent Psychiatry
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Last modified on: 8 September 2017