What is Depression in Childhood and Teen Years?
Depression in childhood and teen years is persistent sadness, loss of interest in activities; as well as, feelings of hopelessness, irritability, and frustration.
“Depression is a diagnosis that includes pervasive sadness or loss of interest in activities your child used to enjoy. Low serotonin levels in the brain can cause depression, and these symptoms can be inherited through genetic predisposition. Situational variables can also impact depression.” 
Symptoms of Depression in Children and Teens
- Loss of pleasure: your child shows less interest or participation in activities they used to enjoy
- Inattention and slow processing speed: your child is seeming unable to focus on anything. May seem lethargic or spacey
- Thoughts of worthlessness or excessive guilt: your child may make a lot of negative self-statements. “I’m not good enough.” “Everyone else can do that but I can’t.” “I never do anything right.”
- Withdrawal or social isolation: your child may stop spending time with friends or family and may spend all their time quietly in a bedroom. Playdates and interest in others may decrease. It is normal for teenagers to pull away from their parents. It is unhealthy for a teen to spend all day, almost every day in their room alone. Children who used to have friends but who start pulling away are showing concerning symptoms. If your child drops out of boy scouts and soccer, preferring to be home alone, depression should be considered.
- Thoughts of death or suicide: your child reports wishing they had not been born, may discuss life without them, and may try to give away treasured possessions. They may express a desire to hurt themselves and may share a plan
- Poor eating: your child may not be interested in eating or may eat excessively with a focus on carbohydrates
- Poor sleep: your child may not be able to sleep or may sleep all the time; generally a disruption in typical sleep patterns is cause for concern
- Irritable mood: your child may seem angry, frustrated, have a short temper, and cry easily. Often depressed children feel more angry or irritable and this can lead parents to miss that depression is the underlying cause
- Low energy: your child or teen may have very low energy all of the sudden. It will be important to rule out medical causes or complications but if there is no medical reason for this symptom depression is a likely cause
- Delusions: some children, teens, and adults who have depression will also have hallucinations or delusions. Mike Wallace, the 60-Minutes correspondent talked openly about his experience with depression and delusions, indicating that it was not a sense of sadness but the sense of feeling crazy that caused the most distress. He describes, “I was out of my mind. I was a little crazy.” Public figures who have bravely shared their personal experiences with depression are shedding light on such challenges, reducing stigma, and allowing others who are struggling to make sense of their own stories. [5,6]
- Substance abuse: your teen may be using drugs or alcohol. It is important to consider their mental health and overall functioning. Not all kids who use drugs will become addicted or depressed. However, depression can be a side effect of drugs or may be associated with poor self-care and destructive behaviors
Causes of Depression in Children
Currently, research shows the most common causes of depression in children are a family history of depression and exposure to stressful life events. 
- Genetics: a genetic predisposition or family history of depression and anxiety is a common cause of depression.
- Loss: can include many things. For example, a child may experience loss from: the death of a parent or grandparent, loss of a friend group, a recent move across the country, or divorcing parents. Loss is anything that was valuable to your child that is no longer there. To feel sad after a loss is normal. Children who lose a parent often will not start the grieving process until after their current caregivers are in a stable place. If it has been longer than six months and you notice your child is not slowly improving over time, it is important to seek help.
- Abuse: repeated exposure to abuse (sexual, physical, verbal, emotional) including witnessing acts of violence can increase your child’s risk for depression
- Peer conflict and bullying: if your child does not feel a sense of belonging and safety at school or at home it can increase the risk for depression.
- Pessimism: An interesting factor to consider is whether you consider yourself and your child to be an optimist or a pessimist. Psychology research has confirmed for decades that optimists find more well-being and success. In his seminal work, the Optimistic Child, Dr. Seligman describes,
“But pessimism is an entrenched habit of mind that has sweeping and disastrous consequences: depressed mood, resignation, underachievement, and even unexpectedly poor physical health.
Pessimism is not shaken in the natural course of life’s ups and downs. Rather, it hardens with each setback and soon becomes self-fulfilling. America is in the midst of an epidemic of pessimism and is suffering its most serious consequence, depression.”  p.7
What to Do About Depression in Childhood
Increase emotional awareness: Help your child recognize their emotions by drawing emotional faces, role-playing, and acting out different emotions. Start with positive feelings and move to sadness, worry, and other negative emotions. When you are watching youtube or tv together, ask your child what different characters in the story may be feeling.
Improve coping skills: Practice skills such as deep breathing, relaxation, reading, listening to music, taking a walk, jumping on the trampoline, talking to a friend, youtube progressive muscle relaxation and practice with your child.
Optimism: If your child is a pessimist, the Optimistic Child has some good suggestions. For now, there are a few basic ideas for ways to foster more optimism in your child. It is important to see how your child is ‘attributing’ negative events in life.
Changeable – People who see events as permanent are pessimistic; those who see events as changeable have a more optimistic outlook.
Specific – People who see negative events as global and pervasive have more of a pessimistic view; those who see negative events as specific are generally of the optimistic view.
External – Finally, those who see negative events as internal and general personality traits (“I am such a slob”) are more pessimistic. Those who see events as internal and behavioral (“This room is a mess, but I can clean it up”) tend to be more optimistic.
When bad things happen in your child’s life, help him or her to see the glass as half full by looking at these events as changeable (not permanent), specific (not global), and behavioral (not personality traits). , p.64
Mindfulness: Mindfulness involves recognizing and accepting feelings and allowing them to just be. This practice involves scanning the body to notice any tension and working to let that tension go. Awareness of the present time and accepting thoughts and feelings are important in mindfulness practice. It may help to remind your child that feelings are like clouds. We can watch them pass without getting too caught up in their current form.
Watch for fact-finding: Often when we feel sad we think about every event that has ever gone wrong in our life increasing our sadness. Instead, try acknowledging the current feeling of sadness without adding to it by connecting that event with other unpleasant circumstances or events.
Spend time together: Read together, watch movies, and visit the zoo or the park. Just take time to be together. Be careful of your tone and your own irritability around your children.
Listen to your child: When your child shares symptoms or negative self-statements like “I hate myself,” hear them. Never say “no you don’t.” Instead, say, “I hear that you feel really awful right now. I’m here to help. Together we can try to make it better.”
Get your child involved: Guide your child to take part in pleasant events that he or she used to enjoy. If your child used to like dance class, is she interested in trying a new class? If your child used to play guitar, does he want to get involved in a local music school or band?
Support your child in identity formation: Older children and teenagers tend to be in the phase of identity development. It’s your child’s chance to really decide what he or she stands for, and what is important. Help your child truly explore who he or she is by:
- making a collage
- taking an art or pottery class
- picking up a new instrument
- identifying places he or she would like to visit
- checking out some books of interest at the library
Build healthier habits: Patiently work with your child on eating, sleeping, exercise, and social patterns. Healthy habits help foster resilience and overcome depression symptoms.
When to Seek Help for Depression in Childhood
Depression is a common diagnosis and can be treated. Know that your child can feel better. Early treatment is the best course of action because if left untreated depression can get worse.
It is valuable to obtain a diagnosis and to engage in the appropriate therapies as early as is feasible. With these supports in place, it is possible to see meaningful improvement in depressive symptoms, better coping skills and emotional awareness, and the potential to live a happy life.
Keep an ear out for suicidal thoughts: If your child talks a lot about death and dying, there may be serious safety concerns. In that case, seek help right away. You can call 911 or go to the emergency room if your concerns are significant. Also, consider reaching out to the school counselor or school psychologist.
Professional Resources on Depression in Childhood:
If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.
Psychotherapy: This type of therapy occurs in an office with a psychologist or therapist (a mental health professional) and is often focused on improving emotional awareness, coping skills, and restructuring negative thoughts. The psychotherapy modality that has the most research for treating depression is cognitive-behavioral therapy (CBT). Mindfulness may also be helpful as a technique. It teaches awareness of emotions, acceptance, relaxation, and meditation.
Play therapy: For young children, play therapy utilizes toys and art to allow a child a safe setting to act out their feelings and experiences. Guided play therapy can introduce coping skills and emotional awareness into the play themes.
Parent consult with a licensed psychologist: Parent consultation can follow a CBT or a Family Systems model and can provide guidance to parents on strategies to use to hear and support their child and to help them feel understood. It also may focus on principles of reinforcement by noting that punishment is not effective for depressed children. Consultation can also focus on the parent’s experience and emotional well-being.
Psychiatry: Keep your child’s doctor in the loop about your child’s mental health. You can request a referral to a child psychiatrist from your pediatrician to learn more about the benefits and side effects of medication. Sometimes children with depression do take antidepressant medication prescribed by a psychiatrist. Usually, this medication is to treat low mood and to increase serotonin in the brain (selective serotonin reuptake inhibitor or SSRI). Medications can be quite effective for these symptoms.
School services: School-based supports, such as an IEP or a Section 504 plan, can help your child receive accommodations and modifications that they may require to access learning in the classroom setting.
Emotional disabilities, such as depression, can impact school performance and social skills. Individual meetings with the school counselor or school psychologist may provide emotional support. Assignment of a peer buddy or mentor at school can help. Positive event scheduling and a lunch bunch or social group may also help build peer support.
In order to write a formal plan, your school team will need to find an educational impact of the depressive symptoms in some aspect of your child’s education.
It may be easier to obtain support through a Section 504 plan if your child’s grades and test scores are not impacted. A 504 Plan requires a medical condition that impacts functioning, but academics and test scores need not be directly impacted.
An IEP is a more detailed document that does require a clear educational impact of symptoms. In addition to emotional support, goals in an IEP would also address challenges in reading, writing, math, or communication. Ask your school about both an IEP and a 504 to determine which plan would best serve your child.
Similar Conditions to Depression in Childhood
If your child is struggling with a similar problem, not directly addressed in this section, see the list below for other related symptom areas.
- Sadness related to attachment: was there a death in the family or loss of a caregiver? Keep in mind that it is not unusual for a child to be depressed after the loss of a loved one or a change in caregivers
- General anxiety: depression and anxiety fall on a continuum. Extreme anxiety can lead to feelings of worthlessness and can result in depression. Psychologists sometimes call persistent anxiety ‘the eroding of the coping structures’ because if we are stressed for too long, we lose our ability to handle setbacks and frustrations. Many people will become depressed over time if that anxiety goes untreated
- Learning challenges: such as dyslexia or dysgraphia that may lead to lowered self-esteem and can develop into depression
- Bipolar disorder: children with bipolar disorder have been misdiagnosed and misunderstood for decades. The recognition of bipolar in children was largely attributed to the excellent work of Demitri Papolos, MD, and Janice Papolos in the Bipolar Child. Children with Bipolar often have erratic behaviors, outbursts, meltdowns, hyperactivity, thought disturbances, attention problems, and extreme challenges functioning in school and social relationships. In this important book, these doctors describe the detrimental effects of many psychotropic medications that were erroneously prescribed due to a misdiagnosis of Depression or ADHD. These medications are not only ineffective but can make bipolar symptoms much worse
- Developmental trauma: Dr. Heller teaches in Healing Developmental Trauma that the traumatized child dissociates from their experience using an ‘adaptive survival style’ . For example:
- Connection survival style: A child who feels unsafe in the care of others will have intense fears of being close to people, will disengage from others, and attempt to be invisible
- Trust survival style: A child who feels it is unsafe to trust others will give up authenticity in order to be what people want them to be
- Attunement survival style: A child who feels the environment is not attuned to their needs will decide to ignore their own needs and attune to the needs of others
- Autonomy survival style: A child who feels it is unsafe to say ‘no’ to parents will go along with the agenda but secretly resent or rebel against an authority figure’s expectations
- Love survival style: A child who believes that the only way to get love is to perform or achieve, will go to extreme lengths to impress others
Children who are using one of these adaptive survival styles to cope with developmental traumas are likely to have disturbances in their relationships that can lead to mental health problems, including depression.
Book Resources for Depression in Childhood
 Barbara Maughan, PhD, Stephan Collishaw, DPhil, and Argyris Stringaris, MD (2013). Depression in Childhood and Adolescence
 Beck, Judith S. & Beck, Aaron T. (1995). Cognitive behavior therapy, 2nd edition: Basics and beyond.
Seligman, Martin E.P. (1995). The optimistic child: A revolutionary program that safeguards children against depression and builds lifelong resilience.
 Lawrence Heller. Healing developmental trauma: How early trauma affects self-regulation, self image, and the capacity for relationships
 Mikaela Conley (April 2012). Mike Wallace’s Battle With Depression and Suicide
 Brainline (February 2022) Depression with Mike Wallace
Knaus, William & Ellis, Albert (2012). The cognitive behavioral workbook for depression: A step-by-step program.
Huebner, Dawn (2006). What to do when you grumble too much (A kid’s guide to overcoming negativity).
Emberley, Ed & Miranda, Anne (1997). Glad monster, sad monster.
Curtis, Jamie Lee (2007). Today I feel silly.
Cain, Janan (2000). The way I feel.
Lichtenheld, Tom (2007). What are you so grumpy about?
Eastman, P.D. (2003). Big dog…little dog.
Knaus, William & Ellis, Albert (2012). The cognitive behavioral workbook for depression: A step-by-step program.
Schab, Lisa M (2008) Beyond the blues: A workbook to help teens overcome depression.
Cook, Julia (2018) A flicker of hope
Cook, Julia (2012) Blueloon
Cook, Julia (2013) Blueloon Activity and Idea Book
Kent, Jack (2009) There’s no such thing as a dragon.