Depression in children

Can children have depression?

Yes. Many adults don't realize it, but children can suffer from depression. Until the mid 1980s, when research proved otherwise, depression wasn't even recognized as a childhood disease. We now know that kids as young as 2 years old can be identified with a depressive disorder, and even infants can suffer from depression. We also know that it's a serious – and treatable – illness.

Before puberty, depression affects boys and girls equally, but after puberty, the rate is about twice as high for girls. Depression is also more common in adolescents than in younger children. In 2019, one fifth of young people ages 12 through 17 had ever had a major depressive episode, 36.7 percent reported sadness, and 18.8 percent had considered suicide.

Unfortunately, depression rates have climbed significantly since the COVID-19 pandemic began. Social isolation, school closures, missed milestones, and increased family stress are all to blame.

One global mental health analysis of kids from 4 to 19 found that 23 percent reported having depression in 2020, second only to anxiety at 28 percent. (Researchers looked at 35 survey studies of more than 65,000 children.)

According to another analysis, one in four youth globally are now experiencing clinically elevated depression symptoms. (Researchers reviewed 29 studies of more than 80,000 children 18 years or younger worldwide.) Symptoms were worse in studies that were collected later in the pandemic, in older children, and in girls.

Horribly, emergency department visits for suicide attempts among adolescents in the U.S. rose 31 percent in 2020 compared with 2019. Those numbers have continued to rise: In February and March of 2021, ED visits for suicide attempts rose 51 percent among girls aged 12 through 17 compared with the same months in 2019. (For boys the ED visit rate for suicide attempts rose 3.7 percent.)

Faced with these disturbing statistics, what's a parent to do? Read on to learn how to support your sad or depressed child, when to get help, and what to do if your child talks about suicide.

If my child is sad a lot, does this mean they have depression?

Not necessarily. It can be tough to tell whether your child's behavior is normal or something to worry about. We all – including children – feel blue or down in the dumps now and then, or are sad about a particular situation. But depression isn't the same as an episode of sadness.

Clinical depression is a type of mood disorder, beyond the normal sadness a child might occasionally feel. The condition is marked by a sense of hopelessness and a lack of energy and enthusiasm that can last for weeks, months, or (in rare cases) even years at a time.

If your child is sad or irritable for weeks at a time, or if they no longer enjoy things, they may be suffering from depression. Depression can range from mild to major, but a child with even mild depression usually shows symptoms that interfere with their ability to function well at home, at school, or with friends.

The good news is that early detection and treatment can help your child feel like themself again – and make it less likely that they'll suffer from depression in the future. The key is identifying the problem and getting help.

Talk with your child's doctor, who can screen your child for depression and help you understand whether your child's behavior is cause for concern. If necessary, they can refer you to a child psychologist, psychiatrist, or other licensed mental health professional trained to work with children.

What are the signs and symptoms of depression in children?

Signs and symptoms of depression can be different in children than in adults. Children are less likely to be able to express their feelings and are more likely to experience physical symptoms.

Depression can affect your child's behavior in many ways. Common signs and symptoms of depression in children include:

• Frequent sadness or tearfulness
• Irritability, crankiness, or disagreeableness
• Increased physical agitation, such as being more fidgety or hyperactive than usual
• Anger or defiance
• Mood swings
• Lack of interest in things they used to enjoy
• Trouble getting along with other children and family members
• Spending less time with friends or in after-school activities
• Social withdrawal
• Lack of energy, tiredness, and fatigue
• Sleeping problems
• Appetite and weight changes
• Inability to concentrate
• Low self-esteem and guilt
• Sense of hopelessness and helplessness
• Preoccupation with themes of death or suicide (or attempts at self-harm) demonstrated verbally, in behavior, or in play
• Not doing as well in school, not caring about school
• Frequent complaints about headaches, stomachaches, and other physical ailments

Note: If you have any reason to fear your child might hurt themself or others, contact their doctor immediately.

What causes childhood depression?

Depression is caused by a combination of biological and environmental factors.

Scientists think that depression is related to changes in brain chemistry, especially involving chemical neurotransmitters that help relay messages from one nerve cell to another. When there's a drop in certain neurotransmitters, the brain doesn't function normally, which can lead to depression and other forms of mental illness. A family history of depression – especially if a parent had depression in childhood – increases the risk of depression.

But depression can be rooted in other things besides genes and biology. Environmental risk factors for depression may include:

• Abuse or neglect, abandonment, and/or major separations from primary caregivers during early childhood
• Excessive stress, such as family conflict or financial problems, chronic school problems, or a difficult move
• Loss of someone close or loss of a beloved pet
• Trauma (physical or emotional)
• Other developmental, learning, conduct, or psychiatric disorders (Children who are depressed sometimes have other mental health difficulties at the same time, such as anxiety, attention deficit disorder, conduct disorders, eating disorders, or substance abuse problems.)
• Other chronic illness

How is depression in kids treated?

It's very important to get help for your child if they're suffering from depression. Depressed children can get behind on schoolwork, lose friends, and miss out on activities. Children and adolescents who are depressed are more likely to get into trouble, and have a higher risk of drug use and suicide.

The good news is that depression is one of the most treatable mental disorders. For mild to moderate depression, therapy is often enough. For more severe cases of depression or cases that don't improve with therapy, a combination of medication and counseling is usually recommended.

Therapy

Psychotherapy, especially cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), can effectively treat depression. For young children (ages 2 through 6), play therapy and/or parent-child therapy can be effective.

Cognitive behavior therapy (CBT) is the treatment most often used for depression in children. CBT teaches a child that they're having harmful thoughts that can be replaced with more positive thoughts – those that are linked to better feelings. It can help a child learn new coping and problem-solving skills and self-control.

Play therapy is a CBT technique that may be used with younger, less verbal children, who can express themselves more easily through play. A therapist might also recommend family therapy (with the child, parents, and siblings, for example) or parent counseling as well as group therapy. Group therapy would include a number of other children (usually fewer than 10) who are dealing with similar problems.

Interpersonal therapy (IBT) focuses on interpersonal relationships. Through talking and role play, the therapist helps a child identify how they might improve relationships with family and friends. IBT can help a child who is grieving after losing a loved one, having conflict in important relationships, having trouble adapting to changes in relationships or life circumstances, or having difficulties with social isolation. Like CBT, IBT may also include family, parent, play, and/or group therapy.

Antidepressants

Antidepressants can help correct a chemical imbalance contributing to depression, but they're not an easy cure-all. Experts usually recommend trying therapy first for children with mild to moderate depression and reserving antidepressants for persistent, severe depression.

Side effects are one concern. With children and young adults under 25, for example, some of the medications intended to improve mood can have the opposite effect, leading to suicidal thinking and even suicide attempts.

Also, using medications can mask the real cause of the depression and keep a child from getting effective treatment. For example, a child who's depressed because of family discord or conflict with a teacher would be best served by a change in the situation that's making them depressed.

That said, the benefits can far outweigh the risks, and there are safe antidepressants for children who need them. Talk with your child's doctors about all possible risks and benefits associated with antidepressants and carefully observe your child if they're taking these medicines. Any decision about using medication should be made collaboratively by you, your child, and all their healthcare providers.

In most cases, your child's doctor will start by prescribing one medication, work with you to determine if it's helping, and monitor your child for side effects. Depending on your child's response, their doctor may adjust the dosage or switch to another medication. Medication usually takes at least a week or two – or as long as a few months – to take effect.

The antidepressants that are most often prescribed for depression in children are selective serotonin reuptake inhibitors (SSRIs) – such a fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).

If your child doesn't respond to an SSRI, their doctor may recommend another, non-SSRI antidepressant, such as bupropion (Wellbutrin), desvenlafaxine (Pristiq), or duloxetine (Cymbalta).

Experts stress that even when medication is appropriate for kids, it must be combined with therapy. Medication alone won't cure the problem, and it's important that children on antidepressants be monitored closely. Also, depression can be a chronic disease, and to manage it successfully, a child will need help developing their coping skills.

How to find a mental health professional for your child

Talk to your child's doctor, other providers, family members, school counselors, and friends. They may be able to refer you to someone they're familiar with and trust. You can also use online tools, such as those provided by:

• The American Academy of Child and Adolescent Psychiatry provides a Child and Adolescent Psychiatrist FinderOpens a new window to help you find a physician in your area. They also have a resource libraryOpens a new window with information on relevant issues.
• The American Psychological Association provides a Psychologist LocatorOpens a new window where you can search for a psychologist by location and specialty.
• Anxiety & Depression Association of America offers a Find a Therapist DirectoryOpens a new window. They also provide a state-by-state list of ADAA telemedicine health providersOpens a new window.
• The Association for Behavioral and Cognitive Therapies offers a CBT Therapist DirectoryOpens a new window to help you find psychologists, psychiatrists, and clinical social workers trained in cognitive and behavioral techniques.
• Psychology Today's website offers a Find a TherapistOpens a new window link to help you find mental health professionals in your areas.

Most insurance plans provide some coverage for mental or behavioral health services (including Medicaid and the Children's Health Insurance Program), but benefits vary. Ask your insurance provider for details about your coverage, and make sure you understand the out-of-pocket costs.

Once you have the names of several people, start by asking them some questions, such as these, about their background:

• Are you a licensed psychologist/psychiatrist?
• What degrees do you have?
• Are you board-certified? (Ask a psychologist whether they're certified by the American Board of Professional Psychology, and ask a psychiatrist about certification by the American Academy of Child and Adolescent Psychiatry.)
• How long have you been practicing?
• What's your specialty?
• What types of treatment do you usually use?
• How long could treatment take?
• What are your fees? Will you accept my insurance coverage? Do you have a sliding scale fee? Can you set up a payment plan?

If your child has another mental health problem related to depression, such as attention deficit disorder or an eating disorder, look for a professional with expertise in that area, too.

Finally, it's important that you and your child have a good rapport with the provider you choose. Do your best to find someone your child feels comfortable talking to. You can ask to meet with potential therapists in person or over the phone before bringing your child to a session. If you start with a therapist but it doesn't seem like a good fit, consider looking for a new therapist who'd be a better match.

Having a child who's depressed can be very hard on you, too. Do your best to take care of yourself and reach out for help when you need it.

How to help your child with depression

A child with depression is ill and needs your support. Be patient and loving, and avoid blame, sarcasm, and criticism. Make yourself available to listen – without judging – when your child wants to talk. Encourage them to share all of their feelings, including their fears and thoughts about death or suicide. Show confidence in them, and be positive about getting professional help.

Help your child reduce stress:

• Scale back on chores and/or extracurricular activities.
• Talk with teachers about reducing your child's school work load.
• Monitor your child's use of social media, which can expose them to harassment and bullying. Establish guidelines for using social media, and install parental control software.
• Find fun activities for your child to do with you or their friends. Choose activities that build on your child's strengths and interests.
• Encourage them to use mindfulness or relaxation techniques.
• Provide predictable routines, which can increase feelings of security and control.
• Teach them to problem-solve by breaking worries down into manageable difficulties.

Encourage them to take good care of themselves physically by:

• Eating a healthy diet
• Staying active. Exercise has been shown to reduce symptoms of depression and improve mood. Activities that provide a sense of accomplishment, fun, and connection are especially helpful.
• Getting good sleep at night

Stay in close touch with your child's therapist, who can provide guidance on ways to support your child. If your child takes medication, make sure they take it as prescribed. Be aware of possible side effects and warning signs that your child might need urgent help.

What to do if your child talks about suicide

If you think your child is suicidal or they've harmed themself, take them to the Emergency Department at the hospital right away.

Tragically, suicide is something that happens to many children from all backgrounds. Suicide is the second leading cause of death for 10- to 24-year-olds (after accidents) and the sixth leading cause of death for 5- to 14-year-olds. Children and adolescents who try to kill themselves usually have a significant mental health disorder, most often depression.

Teens who attempt suicide are often dealing with stress, self-doubt, disappointment, and loss, while younger children – whose actions are often impulsive – are dealing with sadness, confusion, and anger.

Risk factors for suicide include:

• Family trauma, such as abuse and violence, suicide of a family member, separation from loved ones, and loss of stable housing
• Previous suicide attempts. Self-harm (such as cutting) also increases the risk of suicide.
• Hostility and rejection related to sexual orientation or gender identity
• Racism
• Depression and other mental health conditions, such as eating disorders and mood disorders
• Substance abuse
• Behavior issues, such as extreme anger, aggression, or impulsivity, especially when socially isolated
• Knowing about the suicide of someone the child knows, especially if it's a family member, friend, or peer
• Easy gun access. Guns are the main cause of suicide for teens.
• Bullying. According to a study of more than 96,000 children and adolescents, those who were bullied online were about 12 times more likely to have suicidal thoughts than those who weren't. The risk for self-harming and suicide attempts is also significantly higher for children who are cyberbullied.

In addition to the steps you can take to help your child with depression (above), if your child talks about suicide:

Take them seriously. Don't assume they're "just being dramatic" or overreacting when they say things like "Nothing matters," or "I want to die." These kinds of comments usually mean a child needs help.

Communicate. If you suspect your child is depressed, ask them about it. Tell them you care about how they're feeling and want to talk. If your child says something like, "There's nothing to live for," respond in a way that shows you understand and empathize. For example, say "It sounds like you're really hurting if you're thinking about ending your life," not "I can't believe you think that!"  Don't be afraid to ask them directly if they're thinking about suicide – they need to know they can talk openly with you.

Be positive about getting help. Tell your child that there is help for them and that their depression is treatable. Do your best to remove any shame or embarrassment they may be feeling by explaining that taking care of their mental health is a sign of maturity and self-respect. Explain that many people have mental health problems to sort through at some point. Be realistic with them – it may take some time. But with patience and the right treatment, they can feel better.

Get professional help. Ask your child's doctor or a mental health professional for help right away. A mental health provider can treat your child with therapy and medication and help you both create a plan for dealing with suicidal thoughts – including ways of coping, sources of support, steps to take if the problem worsens, and emergency contacts. Have your child put the suicide hotline number (below) in their phone.

Keep your child's environment safe. Make sure your child can never access dangerous medications, alcohol, tools, knives, guns and other weapons, illicit drugs, potentially poisonous products (such as household cleaners and antifreeze), ropes, belts, or plastic bags.

Here are a couple of good resources for suicide prevention:

The 988 Suicide & Crisis Lifeline allows anyone in the United States to dial 988 to be connected to the National Suicide Prevention Lifeline, a national network of local crisis centers.

#BeThe1ToOpens a new window helps educate about ways to prevent suicide and promote healing. They outline five action stepsOpens a new window for communicating with someone who may be suicidal.

Where can I learn more about childhood depression?

For more information about depression, treatment, and support services, visit the websites of these organizations:

American Academy of Child & Adolescent PsychiatryOpens a new window

American Psychiatric AssociationOpens a new window

National Institute of Mental HealthOpens a new window

National Alliance on Mental IllnessOpens a new window