While the term "depression" can be used to refer to sad mood, clinical depression is more than just feeling blue or down. Children who are clinically depressed feel down, sad, or hopeless all the time, for weeks on end. According to the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-V), in order to meet criteria for Major Depressive Episode, an individual must experience five or more of the following symptoms during the same two-week period and these symptoms must represent a change from previous functioning:
- Depressed or irritable mood most of the day, nearly every day
- Disinterest in things once enjoyed
- Fatigue or loss of energy
- Difficulty sleeping, or sleeping too much
- Significant weight loss or gain, change in appetite, or failure to make expected weight gains (children)
- Difficulty thinking, including inability to concentrate while reading or even watching television
- Being observably agitated or slowed down
- Feeling worthless or overly guilty
- Recurrent thoughts of death or suicide
The following Depressive Disorders are classified as mental disorders:
- Major Depressive Disorder is characterized by one or more
Major Depressive Episodes that last at least two weeks and include depressed or irritable mood or loss of interest, accompanied by at least four additional symptoms of depression. More
- Persistent Depressive Disorder (Dysthymic Disorder) is a more chronic, but low-grade
(less intense) type of depression. It is characterized by depressed
or irritable mood day after day, for at least one year. More
Children and teens may also meet criteria for a mental disorder known as an Adjustment Disorder. What distinguishes an Adjustment Disorder from a primary mood disorder, like depression is the development of clinically significant emotional or behavioral symptoms in response to a specific stressor. Some examples include, divorcing parents, deployment, starting school, etc.
Although Adjustment Disorder is distinct from a primary mood disorder, it does not mean that they are mutually exclusive. An Adjustment Disorder with Depressed Mood is diagnosed when a young person is responding to a stressor with predominantly depressive symptoms. For instance, if a child is isolating, crying, irritable, and having difficulty sleeping during a parent’s deployment, and these symptoms are significantly impacting the child’s ability to function (play with friends, participate in school, etc.), the child may be classified as having an Adjustment Disorder with Depressed Mood.
It’s not always easy to differentiate normal behavior from a Depressive or Adjustment Disorder in young people. Signs of depressive disorders are often viewed as normal mood swings, typical of a particular developmental stage. In addition, health care professionals may be reluctant to prematurely "label" a young person with a mental illness diagnosis. Yet early diagnosis and treatment of depressive disorders are critical to healthy emotional, social, and behavioral development. Children and teens may also exhibit symptoms of depression that do not meet criteria for a mental disorder. The treatment of a mood disorder or other co-occurring disorder may reveal the existence of symptoms previously undetected. It is therefore important to communicate any unexpected changes in behavior with your provider. A mental health or medical provider can help determine if your child or adolescent has a Depressive or Adjustment Disorder, and if so what level of care is needed.
Adolescent symptoms to pay attention to:
- A change in appetite (eating too much or not enough)
- Obsession over body image
- Withdrawing from friends and activities
- Sleeping disturbances
- A decline in grades
- Inability to complete simple tasks
- Change in normal behavior
- Reluctance to participate in social activities
- Frequent stomachaches or headaches that don't respond to treatment
Child symptoms to pay attention to:
- Frequent physical complaints, such as headaches and stomachaches
- Play that involves excessive aggression toward self or others, or that involves persistently sad themes
- Frequent absences from school
- Poor performance in school
- Talk of or efforts to run away from home
- Outbursts of shouting, complaining, unexplained irritability, or crying
- Being bored
- Lack of interest in playing with friends
- Alcohol or substance abuse
- Irrational Fear of death
- Extreme sensitivity to rejection or failure
If your child or adolescent does not meet criteria for a Depressive Disorder, depressive symptoms may still negatively impact his, her, or your family’s life. Young people can sometimes struggle with their mood in response to stressful events, such as changing schools, parents divorcing or remarrying, deployment, facing major disappointments, and so on. Feeling down and sad from time to time is normal. It is important to communicate this to young people, and support them through difficult times. Self-care information posted on this site may be helpful for young people who need help coping with the normal ups and downs of life. If you have any doubt about whether or not your child or adolescent is clinically depressed, consult your pediatrician, primary care manager or a mental health provider.
If you think your child or teen might be depressed check out the Depression Screening Quiz
Depression vs. Bereavement
If your child or adolescent is experiencing depressive symptoms related to the loss of a parent, grandparent, friend, or pet, he or she is suffering from bereavement, not clinical depression. According to the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-V), bereavement is classified as a stressor that may require clinical attention, but it is not a mental disorder. More about bereavement.
With depression, these feelings arise without a loss, or if a loss is experienced by the child, the depressive symptoms last much longer than normal grief.
Certain mental disorders, such as depression, increase the likelihood of suicidal thoughts and behaviors. Suicidal thoughts and attempts are more common in adolescents than children, particularly young children. Survey data from 2011 indicate that 15.8% of high school students had seriously considered attempting suicide, 12.8% had made plans to attempt suicide, and 7.8% had made a suicide attempt during the year preceding the survey.1 More
People consider suicide when they are hopeless and cannot see other options for solving problems. Young people feel stress, confusion, self-doubt, and pressure to succeed. Adolescence, in particular, is time where young people undergo many changes. In addition to normative developmental changes, sometimes children and teens undergo other stressors, such as parents divorcing or remarrying, or moving to a new community or school.2 Individuals who contemplate suicide aren’t "crazy". They often feel terribly isolated; because of their distress, and may not be able to think of anyone they can turn to, furthering the isolation.4 Suicidal behavior is often related to psychiatric disorders, such as depression, substance abuse, or borderline personality disorder. Risk factors include: 5
- Depression, other mental disorders, or substance abuse disorder
- A prior suicide attempt
- Family history of a mental disorder or substance abuse
- Family history of suicide
- Family violence, including physical or sexual abuse
- Having guns or other firearms in the home
- Incarceration, being in prison or jail
- Being exposed to others' suicidal behavior, such as that of family members, peers, or media figures.
Sometimes young people will provide clues or warning signs that they need help, but sometimes they don’t supply any warning signs. Some warnings include:2
- Withdrawing from friends and family and regular activities
- Talking, writing or dropping verbal hints of self loathing ("I’m useless," "I won’t be around much longer")
- Putting personal affairs in order (e.g., giving or throwing away favorite possessions)
- Change in eating and sleeping habits
- Violent actions, rebellious behavior, running away
- Drug and alcohol use
- Unusual neglect of personal appearance
- Significant personality change
- Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
- Frequent complaints about physical symptoms
- Giving verbal hints with statements such as "I won't be a problem for you much longer", "Nothing matters", "It's no use" and "I won't see you again"
If someone you know is exhibiting these signs it is important to ask the individual if they are considering suicide. If they are feeling suicidal, it can come as a great relief to the individual to discover that someone has some insight into how they are feeling. More about warning signs
If a young person tells you they are thinking about suicide, you should take their distress seriously, listen without judgment, and help them get to a professional for evaluation and treatment. If a young person is in imminent danger of harming himself or herself, do not leave them alone. You may need to take emergency steps to get help, such as calling 9-1-1. When someone is in a suicidal crisis, it is important to limit access to firearms or other lethal means of committing suicide, including medications or sharp objects.5
The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week.
1Centers for Disease Control and Prevention. (2012). Youth risk behavior surveillance -- United States, 2011. In: CDC Surveillance Summaries, June , 2012. MMWR 2012;61(No. SS-4), p. 11.
2American Academy of Child and Adolescent Psychiatry (2012). Teen Suicide. Fact Sheets for Families, 10. Accessed 10/10/13.
3American Academy of Child and Adolescent Psychiatry (2012). The depressed child. Fact Sheets for Families, 4. Updated July, 2013.
4Stoney, G. (2001). Suicide FAQ. Healthyplace.com accessed 11/14/2012.
5National Institute of Mental Health. Frequently Asked Questions About Suicide. Accessed 11/14/2012.