Depression in Children and Teens: What You Need to Know

Depression is a mood disorder that brings about feelings of persistent sadness, irritability, hopelessness and loss of interest in activities. It can also affect sleep, eating habits and concentration. In this Q&A, learn more about how depression affects children and how you can help your child from Mai Uchida, MD, director of Early Identification and Prevention of Pediatric Depression and provider in Child and Adolescent Psychiatry at Mass General for Children (MGfC).

How does depression in children and teens differ from depression in adults?

Children, teens and adults who have depression show feelings of sadness, guilt, worthlessness and other mood changes. In children and teens, they will often express feelings of sadness through anger or irritability. Adults who have depression will often withdraw from friends and family. Children and teens might withdraw from family, but still spend time with friends.

How common is depression in children?

Depression affects 1 out of every 13 teens ages 13-18 and 1 out of 50 children under age 12. The first signs of depression usually appear between ages 10-15.

What are signs of depression in children?

The most common sign of depression in children is depressed mood. This can look like boredom, irritability, annoyance or feeling deflated or flat. Other common signs of depression include:

• Changes in sleeping habits
• Loss of interest in activities
• Appetite and weight changes
• Low energy levels
• Trouble concentrating or making decisions
• Fidgeting or slowed down movements
• Suicidal thoughts. In children, these thoughts are usually expressed in a passive way. For example, a child might say, “I shouldn’t have been born. What’s the point?”

A note about suicidal thoughts...

Suicidal thoughts are different from the intent to complete suicide. If your child makes suicidal comments, this is a cry for help and that something is wrong. Ask your child what is bothering them and how you can help. Asking your child about what is bothering them does not increase the chance of them completing suicide. If you are concerned about your child’s suicidal thoughts or depressed behavior, please speak with the care team.

How do doctors treat depression?

Common treatments for depression can include:

• Medications
• Therapy, especially cognitive behavioral therapy (CBT) or psychodynamic therapy. CBT is a type of talk therapy that helps challenge and change negative or unhelpful thoughts and behaviors. Psychodynamic therapy focuses on improving a person’s level of self-awareness and understanding of how their past affects their present behavior.

How can I help my child with depression?

Stay connected to your child and community

• Talk to your child about their feelings about school or things happening at home.
• Share family history with your child. Let them know they are not alone.
• Let your child know that some people might perceive depression as laziness or crankiness. It is important for your child to know this is not their fault.
• Make positive connections with friends, family and within the community,

Balance activity with rest

• Have your child get outside into the sunlight. Sunlight can help boost your child’s mood and energy levels.
• Find positive activities for your child to take part in, especially physical activities. Physical activity helps the brain release endorphins (feel good chemicals) to lessen symptoms of depression.
• Limit excessive boredom or downtime. Some downtime is helpful and necessary to feel rested and energized. Too much downtime or boredom can lead to persistent negative thought that can make depression symptoms worse.
• Have your child get enough sleep. Proper sleep can help stabilize mood, appetite and energy levels. It can also help improve your child’s mood.

Connect with available resources

• Ask the care team about resources and treatments that are available to your child and family. This might include other medical providers, support groups or reliable websites.
• Arrange for adjustments for your child at school. This can include accommodations listed in a 504 plan or guidelines from the Americans with Disabilities Act (a law that prohibits discrimination against people with disabilities).

Keep it simple

• Break tasks down into smaller parts. Large or complex tasks can be overwhelming for people with depression. Breaking a task down into smaller parts can be helpful.
• Use visuals, lists or graphics when possible. This can help your child understand different concepts and pieces of information in a different, more engaging way.

Think safety first

• Remove or lock up guns, sharp objects, medications or long cables. This can help prevent your child from harming themselves if they are feeling depressed.

What is the connection between depression and bipolar disorder?

Bipolar disorder is a mood disorder that causes unusual and dramatic changes in a person’s mood, energy, activity levels and the ability to carry out their daily activities. For every 100 children who have depression, about 15 of those will develop bipolar disorder.

What are the signs of bipolar disorder?

The most common sign of bipolar disorder is extreme mood swings that range from manic (extreme) highs to depressed lows. These highs and lows in mood usually come and go over the course of weeks or months. First signs of bipolar disorder usually appear around age 25. Some children can show signs as early as childhood and throughout their teenage years.

Other common signs of bipolar disorder include:

• Easily distracted
• Overly talkative or unable to focus on a single topic of conversation
• Flighty or scattered ideas
• Extremely goal-oriented activities that can be hard to distract them from
• Indiscretion (behavior or speech that may be inappropriate or overly sexual in nature)
• Feelings of grandiosity (an unrealistic view that you are superior or better than others in terms of appearance, skill, talent or uniqueness)
• Changes in sleep habits

What are the common risk factors for bipolar disorder?

• Family history of bipolar disorder or other mental illness
• Conduct disorders (such as ODD)
• Emotional dysregulation (trouble controlling emotions or inappropriate expression of emotions)
• Mania or depressed mood brought on by antidepressants
• Suicidal thoughts or mental health hospitalizations
• Psychosis (a mental disorder that disrupts a person’s thoughts and perceptions of reality)
• Early onset mood symptoms (especially in infants or children)