In children and teens, depression doesn’t always look like sadness

Claire McCarthy, MD

Senior Faculty Editor, Harvard Health Publishing

Follow me on Twitter @drClaire

When we think of a depressed person, we tend to think of someone who, well, acts sad. The picture we have in our head is of someone who doesn’t want to get off the couch or out of bed, who is eating much less or much more than usual, has trouble sleeping or wants to sleep all the time, who has trouble with usual daily activities, and doesn’t talk much.

Children and teens with depression can certainly look like that. But depression can play out in different ways, too. Numbers are hard to come by in younger children, but among 12-to-17-year-olds, almost 13% have had a major depressive episode. It’s important to be aware of the signs; depression is a treatable illness — and untreated depression can lead to long-term mental health and physical problems, and possibly even suicide.

Here are some possible signs of depression in youth:

  • Dropping grades. Now, there are lots of reasons why grades can drop — including learning disabilities, ADHD, bullying, or substance use. But whenever a child’s grades are dropping, it’s important to think about depression as a possible cause.
  • Irritability and anger. There are many reasons for this, including temperament, and teens are often irritable and angry. But if it’s new and persistent, or if a child or teen is getting in trouble much more than usual, think about depression.
  • Boredom. When a child who used to be interested in things is suddenly bored all the time, it can be a warning sign.
  • Dropping out of activities. It’s certainly fine for interests to change. But if new ones don’t take their place, that too can be a warning sign.
  • Difficulty with relationships. When children and teens are fighting with friends, or simply spending much less time than they used to with them, that’s a red flag.
  • Dangerous behavior. A certain amount of risk-taking is normal, especially in teens, but if it’s new and persistent, it may not be normal. Any self-injurious behavior, like cutting, merits attention right away.
  • Persistent physical complaints, such as stomachaches, headaches, or other pain. Obviously you need to get a thorough checkup for any persistent pain. But the mind-body connection can be very strong; sometimes people who are depressed have physical pain that feels very real.
  • Fatigue. This is another symptom that needs to get checked out thoroughly, as there are many medical reasons why a person can have chronic fatigue. But depression is one of them.

If you are seeing any of these in your child — or any other changes in behavior that you can’t explain and don’t seem right to you, talk to your doctor or seek out a mental health professional in your area. Don’t ignore the behaviors or try to explain them away. Better safe than sorry, and as with so many conditions, the sooner you catch depression, the easier it is to treat.

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