Recognizing Depression in Children

As any parent or teacher can tell you, most children experience big emotions such as sadness and hopelessness from time to time, whether it is a preschooler with separation anxiety or a teen in the throes of middle school drama. However, as many as 2 to 3 percent of children ages 6 to 12 and 6 to 8 percent of teens may have serious depression, and suicide is the second-leading cause of death in young people ages 10 to 24.

“Depression is probably our most common mental health disorder that we see in children, and with the increasing rate of suicide in children, it’s a national crisis,” says UNC Health child and adolescent psychiatrist Amy Ursano, MD.

Here’s what you need to know to help a child with depression.

Know the Signs of Depression in Children

It’s sometimes hard to distinguish between what is a normal part of childhood and what is cause for concern, but here’s what to look for:

  • Irritability
  • Persistent feelings of sadness or hopelessness
  • Inability to enjoy things as much as they used to (anhedonia)
  • Changes in appetite—eating too much or too little
  • Changes in sleep—sleeping too much or too little
  • Fatigue
  • Substance abuse
  • Physical complaints in younger children, such as persistent headaches or stomachaches
  • Frequent tantrums
  • Expressing thoughts of death or suicide

“I think one of the big differences in symptoms between children and adults is that depression often expresses itself as irritability in kids,” Dr. Ursano says. “So they may not look sad, but they may be extremely irritable, and that could be the leading symptom. It can be confusing.”

An example of anhedonia—the psychiatric term for the inability to feel pleasure—is if your child used to craft or go kick the soccer ball or read voraciously and now he or she doesn’t want to do it, “or the energy it takes to get them to do it seems like a lot for you both,” Dr. Ursano says.

Although some of these behaviors are normal, pay attention to how long they last, Dr. Ursano says. For example, these behaviors are not an unusual response to a stressful event, such as a death in the family or a close friend moving away. But if they are not tied to a life change or if they last for more than a couple of weeks, it could be a sign of depression.

Get Help if You Suspect Your Child Is Depressed

First and foremost, if your child’s behavior is unsafe or if your child talks about wanting to harm him or herself or someone else, seek help immediately. Call 911 or go to the nearest emergency department. You also can call the 988 Suicide & Crisis Lifeline, available 24/7.

If you’re unsure but think your child may be depressed, talk to your child’s pediatrician.

Treatment for depression usually includes psychotherapy (talk therapy) for your child, but it also can include medication, family counseling and even therapy for parents, too.

“Psychotherapy alone is very common and effective, particularly for mild to moderate depression,” Dr. Ursano says. “A therapist is able to help talk through, think through and develop some coping skills with both the child and the parent. Helping parents better understand the child’s perspective and needs during these vulnerable times can be very powerful.”

When choosing a therapist, keep in mind that it may take time to find the right fit for your child.

“You may have a very reputable clinician that you’re working with, and maybe you all hit it off great and it’s a good fit, but maybe it’s not, and that’s OK,” Dr. Ursano says. “You want to be able to feel like you can speak your mind and that your experience, observations and concerns can be heard and understood.”

Medication can also be helpful. A child psychiatrist may provide both therapy and medication. Alternatively, a psychiatrist or your child’s pediatrician can prescribe medication while your child is in therapy with another provider. This therapist might be a psychologist or licensed clinical social worker. Good communication and collaboration is essential.

“There are a series of medications that have been shown to be effective in children with depression,” Dr. Ursano says.

For severe depression, your child may need more intense therapy or hospitalization.

“Sometimes children will participate in therapy in a more intensive way. This could be outpatient therapy more than once week, or some families will have therapists come into their home to provide treatment for the child and the family there,” Dr. Ursano says.

With more severe depression, when there are worries about safety or suicidal ideation, adolescents may need a hospitalization or a residential treatment facility.

“There are many different levels of care available for children and adolescents with depression. The need varies between children and over time,” Dr. Ursano says. “This can be very stressful for everyone, but it is important to remember that depression is treatable. There are lots of avenues to getting help and feeling better.”

If you think your child may be depressed, talk to your child’s doctor. Need a doctor? Find one near you or set up a virtual appointment.