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Depression in Children and Teenagers

Depression in Children and Teenagers

(This article was first printed in the Special Health Report from Harvard Medical School "Understanding Depression". For more information or to order, please go to

While some idealize childhood, painting it in rosy hues, children may feel shaken by developmental changes and outward events over which they have little or no control. Depression strikes as many as 2.5% of children and 8.3% of teens in the United States. And the number of children and teens in distress may be rising. Recent research published in Pediatrics examined psychosocial issues in thousands of children ages four to 15 during pediatric visits for common health concerns. The study found significant increases in reports of emotional problems, including depression and anxiety, between children studied in 1979 and those seen in 1996.

While a full-blown depression most often starts in mid-adulthood, low-grade depression, or dysthymia, may begin during childhood or the teenage years. The diagnosis of dysthymia in adults is based on depressive symptoms over a two-year period. In children, a diagnosis is made after one year. When dysthymia appears before age 21, major depressive episodes are more likely to emerge later in life.

Among teens as in adults, bipolar disorder and depression are clearly connected. Within five years of experiencing a major depression, 20% to 40% of teenagers develop bipolar disorder. While rare in early childhood, this disorder occasionally appears as a child grows into adolescence, especially in cases where a family history exists. Bipolar disorder that emerges during puberty often displays a mixture of high and low symptoms or rapid cycles of highs and lows.

Rates Change After Puberty

Before puberty, neither sex has the edge on major depression, but afterward girls are two to three times more likely than boys to suffer from it.

Just as adults differ in how they feel and express depression, so do children. Young children are more likely to express feelings of depression as vague physical ailments, such as persistent stomach aches, tiredness, and muscle aches. While they may truly be sad, depressed children and teens are more likely to appear irritable. Social withdrawal is common among children experiencing depression, as it is among adults, although oversleeping and sluggishness are less prevalent. Otherwise, the symptoms of depressive disorders in children, teenagers, and adults are generally similar (see What Is Depression?).

Red Flags

If you are a parent of a teenager, a list of depressive symptoms may make the hairs on the back of your neck rise. Storminess, apparent exhaustion, apathy, irritability, and rapid-fire changes in every realm, including appetite and sleep habits, are common in adolescents. You might find yourself wondering whether a sudden disinterest in the clarinet signals depression or merely that your teen suddenly perceives playing in the school band as totally uncool. Staying up late and sleeping until noon or throwing over one interest in favor of others probably doesn’t signal depression. But constant exhaustion and an unexplained withdrawal from or loss of interest in friends and activities a child once enjoyed would be reason for concern.

Because depression in children and teens often coexists with behavioral problems, anxiety, or substance abuse, experts consider a wide range of potential indicators, such as:

  • Poor performance in school or frequent absences
  • Efforts or threats to run away from home
  • Bursts of unexplained irritability, shouting, or crying
  • Markedly increasing hostility or anger
  • Abuse of alcohol, drugs, or other dangerous substances
  • Social isolation or loss of interest in friends
  • Hypersensitivity to rejection or failure
  • Reckless behavior

You should discuss any of these problems with your child. If you’re still concerned, speaking with your child’s pediatrician or guidance counselor may help.

Signs of Mania

Aside from the typical signs of manic behavior (see What Is Bipolar Disorder?), teens who are in a manic episode may:

  • Talk very fast
  • Be very easily distracted
  • Get much less sleep than usual, but seem to have the same amount of energy or even more
  • Have extreme mood changes, for example, shifting between irritability, anger, extreme silliness, or high spirits
  • Indulge in, think about, or describe hypersexual behavior

If you notice these symptoms, your child’s pediatrician can help you decide whether to seek professional help. Of course, this is especially important if a family history of bipolar disorder exists.

Dealing with Suicidal Remarks

Children and teenagers are by nature more impulsive than adults, their emotions less tempered by experience. In addition to what experts know about the challenges of growing up, research suggests that regions of the brain that govern judgment are not well developed until later in life. All too often in this age group, suicidal thoughts translate into action. It’s important never to ignore or brush off comments about suicide or even such sweeping, dramatic statements as “I wish I was dead,” or “I wish I’d never been born.” Instead, follow through by talking to your child about them.

Perhaps these sentiments reflect nothing more than an isolated, angry outburst or hyperbole in the middle of an argument. But you can say, “Tell me what you’ve been thinking about that,” or “Are you telling me about your frustration, or do you really feel like ending your life?” If the answers you get raise any concerns, if your child refuses to engage in any conversation, or if he or she seems to have any of the signs of depression or mania mentioned earlier in this section, call his or her pediatrician for advice. Pediatricians are trained to look for signs of mental illness and may suggest further evaluation or treatment, if necessary.

Sadly, research on children and teens suffering from mental illness has lagged. But recent studies show that certain antidepressants, such as fluoxetine (Prozac) and paroxetine (Paxil), are relatively safe and do help, particularly when coupled with certain types of psychotherapy. Depending on where the problems are—in the child’s development, in social situations, or at school—therapy can counter negative thoughts and behaviors, help with relationship problems, or provide other forms of support. (See Psychotherapy for Depression.)

More information should become available in the next few years as findings filter in from a multisite study, sponsored by the National Institute of Mental Health, on long-term treatment for depressed adolescents.

(This article was first printed in the Special Health Report from Harvard Medical School "Understanding Depression". For more information or to order, please go to

Understating Depression: a special report on mental health

Understanding Depression

Depression affects nearly 19 million adults each year, yet this common disease is often misunderstood or misdiagnosed. While depression can’t simply be willed away by "shaking off" your blues, there are many effective treatments that can bring joy back into your life. Reading Understanding Depression and sharing it with those closest to you might help improve your life — or the life of someone close to you!. Read more »