Depression in Children: Signs, Causes, Prevention, and Treatment

Feeling sad, acting grouchy, or being in a bad mood are all normal emotional experiences for kids. However, when a sad or bad mood lasts for weeks or even longer and your child’s behavior changes, then it might be a sign of something more serious. Depression in children is a common occurrence [*], perhaps more common than many of us anticipate it to be. Understanding the signs and causes as well as getting the right treatment for this condition can help your depressed child feel better.

What is Childhood Depression?

Childhood depression is a common but serious mood disorder that can cause children to feel sad, hopeless, miserable, and irritable. They may describe this feeling as “down” or “grumpy.”

While it is normal for children to feel sadness or irritation for short periods due to life events (e.g., fighting with a friend), they usually feel better after a while. However, depression is a lingering feeling of sadness, hopelessness, and irritability. It can last for weeks or months and interfere with a child’s concentration, energy, appetite, and sleep. Your child may not enjoy their hobbies or activities like they once used to, and depression can even lead to suicidal thoughts.

Signs of Depression in Children

Depression manifests in different ways for each child, but several telltale signs may indicate that your child has this condition. Here are some emotional, behavioral, and cognitive signs of depression to watch out for:

Emotional Signs

• Sadness or a low mood that does not go away
• Feelings of worthlessness or guilt
• Being irritable or grumpy all the time
• Talking about feeling guilty or worthless
• Feeling empty or unable to feel emotions (numb)
• Crankiness or anger
• Feelings of hopelessness

Behavioral Signs

• Vocal outbursts or crying
• Social withdrawal
• Not having much confidence
• Inability to relax
• Fatigue and low energy
• Not being interested in things they used to enjoy
• Feeling exhausted a lot of the time
• Having trouble sleeping or sleeping more than usual
• Interacting less with friends and family
• Being more sensitive to rejection
• Eating less than usual or overeating
• Having big changes in weight
• Self-harming, for example, cutting their skin or taking an overdose
• Physical complaints (such as stomachaches and headaches) that don't respond to treatment
• Trouble during events and activities at home or with friends

Cognitive Signs

• Impaired thinking or concentration
• Thoughts of death or suicide
• Indecisiveness

Common Types of Depression in Children

There isn’t just a single type of depression that can occur in children. In fact, many types of depression can manifest, and it is important to know the distinctions between them.

• Major depressive disorder. Also called clinical depression, major depressive disorder (MDD) is the most well-known type of depression in children. When a child has MDD, they may feel sad, hopeless, or angry easily. Children with MDD often feel disengaged from family and friends, do not enjoy their hobbies and activities in the same way, and have trouble sleeping or sleeping too much.
• Disruptive mood dysregulation disorder. Disruptive mood dysregulation disorder (DMDD) involves having frequent angry outbursts or temper tantrums that are not considered appropriate for a child’s age. Children with DMDD may be aggressive, both verbally and physically. In such cases, it is good to inform your child’s pediatrician of your child’s behavior. This diagnosis is only done for children aged six and up.
• Dysthymia. Dysthymia is milder than MDD but has similar symptoms that last longer. Children may have symptoms that come and go for years, such that it feels like an ingrained part of their personality.
• Seasonal affective disorder. The symptoms of seasonal affective disorder (SAD) are similar to MDD but they are influenced by the seasons. Children may have such symptoms during the colder, darker months, but it can also happen during any seasonal change.

Causes of Child Depression

There is no single cause of depression. It can happen for many reasons and has many different triggers. Here are some of the most well-known causes for depression in children:

Biological Causes

• Chemical imbalances in the brain. The physiological origins of this disorder suggest that there may be imbalances in the brain, particularly with neurotransmitters like serotonin and norepinephrine.
• Abnormal brain structures. Abnormal brain structures can also influence the likelihood of developing depression in children.
• Genes. Depression often runs in families, which suggests that children can inherit genes that make them more vulnerable to developing the condition [*].

Environmental Causes

• Prenatal conditions. Studies have found that reduced fetal growth is associated with a small but significant increase in the general factor of psychopathology as well as a moderate increase in specific neurodevelopmental factors. Preterm birth and poor fetal growth have been associated with depression [*].
• Maternal depression during childhood. Maternal depression can interfere with the environment needed for healthy child development. It can produce disrupted parent-child relationships, economic hardship, and a disorganized home, all of which can influence the development of depression in children.
• Childhood bullying. Childhood is one of the most potent risk factors for depression in children. In fact, a study found that the risk of depression in children and adolescents who were bullied was 2.77 times higher than those who were not bullied [*].
• Death of a parent. Children are most vulnerable to developing depression following the death of a parent in the first two years of bereavement [*]. Incidences of depression were higher in children aged 12 or younger.
• Natural disasters. Natural disasters may cause economic losses and psychological trauma that contribute to a distressing environment. Both short-term and long-term depression are associated with natural disasters. The prevalence of depression after natural disasters ranged from 7.5% to 44.8% in children [*].

Psychological Causes

There are various psychological determinants of depression, including [*]:

• Having a negative self-concept
• Neuroticism
• Sensitivity to rejection
• Rumination
• Negative emotionality

Risk Factors for Childhood Depression

Many risks may contribute to childhood depression. These include:

• Having a close family member with depression
• Adverse childhood experiences
• Being assigned female at birth
• A history of depression, anxiety disorders, gender dysphoria, attention-deficit/hyperactivity disorder, or conduct issues
• Family conflicts
• Identifying as LGBTQAI+
• Bullying
• Loss of a loved one
• Medical history, including low birth weight, brain injury, or chronic illness
• Problems with friends

How is Depression in Children Diagnosed?

If you suspect that your child is showing signs of depression, then the first priority is to contact your healthcare provider. It is best to start with your child’s pediatrician, who may refer you to a mental health professional for a more comprehensive evaluation.

Your child’s pediatrician may start by ruling out conditions that may be causing mood issues. Illnesses that are known to cause symptoms of depression include:

• Diabetes
• Epilepsy
• Chronic pain
• Vitamin D deficiency
• Anemia
• Concussion
• Hypothyroidism
• Hyperthyroidism
• Mononucleosis

If your child’s pediatrician can’t link their mood changes to a physical problem, then they may refer you to a mental health professional, such as a therapist, child psychologist, or a psychiatrist.

Diagnosing depression in your child will start with a mental health professional talking to both you and your child. They will ask a series of questions about your child’s behavior and mood. They will ask your child to share any symptoms they notice and when they notice them. You might be asked to complete surveys. A mental health professional may also ask to speak to your child’s teacher or other caregivers to gather more information about your child’s symptoms.

There are certain symptoms that need to be met when diagnosing depression. Individuals, including children, “must have five depression symptoms every day, nearly all day, for at least 2 weeks. One of the symptoms must be a depressed mood or a loss of interest or pleasure in almost all activities. Children and adolescents may be irritable rather than sad [*].”

Complications Related to Childhood Depression

There are some complications that may arise as a result of depression.

• Suicidal thoughts or behavior
• Chronic illness
• Digestive disorders
• Substance use

How to Prevent Depression in Children

There are several ways to prevent depression in children. Here are some key things you can do for your child:

• Regular exercise. Getting physically active is one of the best things you can help your child with to better their mental health. Exercise helps prevent and treat depression in several ways, including the release of endorphins, increasing body temperature to calm the central nervous system, and reducing immune responses that may worsen depression. Encourage your child to join a sports team or a club so they can get enough physical activity and be part of a community.
• Reduce social media use. Studies have shown that spending more time on social media can worsen feelings of depression and lead to low self-esteem [*]. Social media can be addictive, but for many families, it is a necessity to stay connected with others. It may not be feasible to cut out social media completely for your kids, but you can limit their screen time to help prevent depressive symptoms.
• Get enough quality sleep. Good quality sleep is essential for mental and physical health. In fact, having insomnia is highly associated with a greater chance to developing depression [*]. To help your child sleep better, try avoiding screens at least an hour before bed, use a comfortable mattress, and meditate or pray.
• Maintain a strong support system. Children need a strong support system and an active social life to have good mental health. Research has shown that a lack of social support can lead to the worsening of depressive symptoms [*]. Ensure that your child can regularly connect with friends and family, even if people are busy.

Treatment Options for Childhood Depression

Several treatment options are available for children with depression. Here are some of the most effective and well-known ones.

• Cognitive Behavioral Therapy. Cognitive behavioral therapy or CBT is often considered the gold standard when it comes to treating children and adolescents with depression. CBT works by teaching children skills to cope with unhelpful thoughts and depressed moods. Kids work with therapists to meet set goals, such as catching negative thought patterns and improving problem-solving skills. Children can also use depression worksheets to supplement their CBT sessions.
• Dialectical behavior therapy. For older children and adolescents with more severe depression, dialectical behavior therapy (DBT) can be very helpful. DBT is a branch of CBT that was developed for people who struggle with painful emotions, suicidal thoughts, and self-harming behaviors. DBT teaches children with these symptoms to practice mindfulness and develop problem-solving skills such as tolerating distress and improving interpersonal relationships.
• Interpersonal psychotherapy. Social relationships can influence and sometimes maintain depression in children. Conversely, when a child is depressed their relationships may also be affected. Interpersonal therapy addresses a child’s relationships by making them more healthy and supportive. This type of therapy teaches kids to communicate better, handle conflict more effectively, and observe when their relationships are impacting their mood.
• Medication treatment. Medication can also be highly beneficial to children and adolescents with depression. Psychiatrists can evaluate and prescribe medications such as selective serotonin reuptake inhibitors (SSRIs), also known as antidepressants. Popular brands include Zoloft, Prozac, and Lexapro. There are also serotonin-norepinephrine reuptake inhibitors (SNRIs) like Cymbalta and Strattera.
• Support groups. Support groups, whether part of therapy or outside therapy, can be extremely helpful in the treatment of depression in children. Joining support groups teaches them that others share similar experiences, which prevents feelings of isolation and loneliness that can often accompany depression. It also fosters a greater sense of acceptance and belonging [*].

The Bottom Line

Addressing childhood depression requires a multifaceted approach involving early detection, understanding the underlying causes, and implementing effective prevention and treatment strategies. By fostering open communication, promoting emotional well-being, and seeking professional help when needed, we can create a supportive environment for depressed children to navigate the challenges of mental health. Together, let's work towards a future where every child can thrive emotionally and mentally.

References:

1. Centers for Disease Control and Prevention. Data and Statistics on Children’s Mental Health. 8 March 2023.
2. Alshaya DS. Genetic and epigenetic factors associated with depression: An updated overview. August 2022.
3. Petterson E, Larsson H, O’nofrio B et al. Association of Fetal Growth With General and Specific Mental Health Conditions. 6 February 2019.
4. Ye Z, Wu D, He X, et al. Meta-analysis of the relationship between bullying and depressive symptoms in children and adolescents. 30 March 2023.
5. Pham S, Porta G, Biernesser C, et al. The Burden of Bereavement: Early-Onset Depression and Impairment in Youths Bereaved by Sudden Parental Death in a 7-Year Prospective Study. 20 June 2018.
6. Tang B, Liu X, Xue C, et al. A meta-analysis of risk factors for depression in adults and children after natural disasters. 19 June 2014.
7. Remes O, Mendes J, Templeton P. Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature. 10 December 2021.
8. National Institute of Mental Health. Depression. 2021.
9. Zsila A & Reyes M. Pros & cons: impacts of social media on mental health. 6 July 2023.
10. Li L, Wu C, Gan Y, et al. Insomnia and the risk of depression: a meta-analysis of prospective cohort studies. 5 November 2016.
11. Buckman J, Underwood A, Clarke K, et al. Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis. August 2018.
12. Malhotra A & Baker J. Group Therapy. 13 December 2022.