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Depressive disorders in children and adolescents
Medical expert of the article
Last reviewed: 07.07.2025
Depressive disorders in children and adolescents are characterized by mood changes involving sadness, low mood, or anxiety that are severe enough to interfere with functioning or cause significant distress. Loss of interest and pleasure may be as prominent as or more prominent than mood changes. Diagnosis is based on history and examination. Treatment includes antidepressant medication, psychotherapy, or a combination of both.
Overt depressive episodes occur in approximately 2% of children and 5% of adolescents. The prevalence of other depressive disorders is unknown. The exact cause of depression in children and adolescents is unknown, but in adults it is thought to result from the interaction of genetically determined risk factors and environmental stressors (especially exposure to death at an early age).
[ Symptoms of Depressive Disorders in Children and Adolescents
The main symptoms of depression in children are similar to those in adults, but are related to typical childhood problems such as schoolwork and play. Children may be unable to explain their feelings or moods. Depression should be considered when a previously successful child begins to perform poorly in school, withdraws from society, or engages in delinquency.
Common symptoms include a sad appearance, excessive irritability, apathy, social withdrawal, decreased ability to experience pleasure (often expressed as profound boredom), feelings of rejection, unlovedness, somatic complaints (e.g., headaches, abdominal pain, insomnia), and persistent self-blame. Other symptoms may include anorexia, weight loss (or failure to gain weight), sleep disturbances (including nightmares), sadness, and suicidal ideation. Irritability in childhood depression may manifest as hyperactivity and aggressive, antisocial behavior.
Mood disorders can develop in children with mental retardation, but may manifest as somatic symptoms and behavioral disturbances.
Diagnosis of depressive disorders in children and adolescents
Diagnosis is based on symptoms and signs. A thorough history and appropriate laboratory testing are necessary to rule out drug abuse and medical conditions such as infectious mononucleosis and thyroid disease. The history should be aimed at identifying causative factors such as domestic violence, sexual abuse and exploitation, as well as side effects of medications. Questions regarding suicidal behavior (e.g., thoughts, gestures, attempts) should be asked.
It is also important to consider other mental disorders that can cause mental illness, including anxiety and bipolar disorder. Some children who later develop bipolar disorder or schizophrenia first experience symptoms of severe depression.
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Prognosis and treatment of depressive disorders in children and adolescents
Major depression in adolescents is a risk factor for academic failure, substance abuse, and suicidal behavior. If left untreated, remission may occur within 6-12 months, but relapses are common. Moreover, during a depressive episode, children and adolescents fall significantly behind in school, lose important connections with friends and peers, and are at high risk for substance abuse.
An assessment of the child's family and social environment is necessary to identify stress factors that may trigger and exacerbate depression. Appropriate school and family interventions should accompany the primary treatment to ensure appropriate living and learning conditions. Short hospitalization may be necessary in acute episodes, especially suicidal behavior.
The response to treatment for depression in adolescents is generally similar to that in adults. Most studies of depression in adults show that the combination of psychotherapy and antidepressants is superior to either method alone. Treatment for depression in preadolescents is less clear. Most clinicians prefer to treat young children with psychotherapy unless the depressive episode is mild or psychotherapy has previously been ineffective. In more severe cases, antidepressants may be an effective adjunct to psychotherapy.
Usually, the first choice is an SSRI when an antidepressant is indicated. Children should be monitored for behavioral side effects such as disinhibition and agitation. Studies in adults suggest that antidepressants that act on both the serotonin and adrenergic/dopaminergic systems may be somewhat more effective; however, such agents (eg, duloxetine, venlafaxine, mirtazapine; certain tricyclic antidepressants, especially clomipramine) also tend to cause more side effects. These agents may be particularly effective in treatment-resistant cases. Nonserotonergic antidepressants such as bupropion and desipramine may also be combined with SSRIs to increase efficacy.
As with adults, children may experience relapses. Children and adolescents should receive treatment for at least 1 year after symptoms have resolved. Most experts now agree that children who have had 2 or more major depressive episodes should receive ongoing treatment.