The University of Texas System
Texas COVID-19 Mental Health Support Line (833) 986-1919 | Mental Health Resources for Families

Depression

Depressed mood is common among children and adolescents. In some cases, the change in mood is temporary, triggered by stress, trauma, or major life changes. Other times, it becomes more persistent, causing changes in physical and mental functioning that worsen over time. When this is the case, the child or adolescent may be suffering from Major Depressive Disorder (MDD), commonly known as depression.

According to the National Institute for Mental Health, approximately 2-4% of children and 4-13% of adolescents suffer from MDD each year. It causes significant functional problems, including sleep issues, appetite and weight changes, poor school performance, social isolation, family conflict and regressive behaviors. As MDD persists, co-morbid problems can develop, such as attentional problems, anxiety, anger issues, physical illness, substance use, self-harm behaviors, and most seriously, suicidal behavior.

The most important concern when considering MDD in children and adolescents is early identification, referral and engagement in effective treatment. In cases of acute suicidal ideation and behavior, these are emergencies which warrant urgent mental health evaluation. Treatment depends on detailed assessment to confirm the diagnosis, and the method will depend on the severity of the symptoms. Most often, this includes therapy, medication, or a combination of both. Parents should be active participants in treatment, both to provide support to the depressed child or adolescent and to help improve family relationships. In general, mild to moderate depression has a good prognosis in adolescence as long as co-morbid difficulties are prevented. More severe depression often requires intensive treatment and consistent follow-up. The goal of treatment is to restore normal mood and functioning to the child or adolescent, which will help them succeed academically and socially.

Diagnosis

The list below outlines possible signs of MDD. If a child is struggling with any combination of these symptoms for more than two weeks, a mental health professional should be contacted.

  • Frequent sadness, tearfulness, or crying
  • Feelings of hopelessness
  • Withdrawal from friends and activities
  • Lack of enthusiasm or motivation
  • Decreased energy level
  • Major changes in eating or sleeping habits
  • Increased irritability, agitation, anger or hostility
  • Frequent physical complaints such as headaches and stomachaches
  • Indecision or inability to concentrate
  • Feelings of worthlessness or excessive guilt
  • Extreme sensitivity to rejection or failure
  • Pattern of dark images in drawings or paintings
  • Play that involves excessive aggression directed toward oneself or others, or involves persistently sad themes
  • Recurring thoughts or talk of death, suicide, or self-destructive behavior
Treatment

Severity of depressive symptoms and level of functional impairment should guide treatment decisions. Mild cases of depression should be treated with psychotherapy, while moderate to severe depression responds best to combination treatment with psychotherapy plus medication management. Consider CPAN consultation for moderate to severe depression. FDA approved medications for depression include fluoxetine (ages 8+) and escitalopram (ages 12+), though there are cases where other antidepressants may be appropriate.

Rating Scales
Resources for Providers
Resources for Parents, Adolescents, and Children