Depression

What is depression?

Everyone goes through periods of feeling unhappy or listless, even children. But if the feelings are very strong or persist for a long time, they might be caused by a medical problem. Major depression, or simply “depression,” is a serious condition that can take over your child’s mood and thoughts. The good news is that awareness and intervention from parents or other adults can help children with depression live normal and happy lives.

Childhood depression is a mental health disorder characterized by a sad mood that is both prolonged and severe. Typically, children with depression are:

  • in a depressed or irritable mood for most of the day, nearly every day
  • show a noticeable decrease in interest or pleasure in nearly all activities
  • may have severe problems with eating, sleeping, energy, and concentration, feelings of worthlessness or extreme guilt, and even little desire to live

It’s important to understand that your child, or anyone with depression, cannot just "snap out of it." Without treatment, symptoms can last for months or even years.

Depression in children has dramatically increased in recent years. Between 7 and 14 percent of children will experience an episode of major depression before they turn 15. Before puberty, boys and girls are equally at risk for depression. By age 15, girls are twice as likely as boys to have experienced a major depressive episode. Around 80 percent of people with major depression who seek treatment improve, usually within weeks.

What are the symptoms of depression?

While each child may experience symptoms differently, some of the most common include:

  • persistent feelings of sadness
  • feeling hopeless or helpless
  • having low self-esteem
  • feeling inadequate
  • excessive guilt
  • loss of interest in usual activities or activities once enjoyed
  • difficulty with relationships
  • sleeping too much or too little
  • changes in appetite or weight
  • decreased energy
  • difficulty concentrating
  • trouble making decisions
  • suicidal thoughts or attempts
  • frequent physical complaints such as headaches, stomach aches, or fatigue
  • running away or threats of running away from home
  • hypersensitivity to failure or rejection
  • irritability, hostility, aggression

What causes depression?

While the exact cause of depression and other mood disorders is not known, they've been linked to genetics and environmental factors. The most common factors associated with depression include:

  • family history of depression
  • parents’ divorce
  • excessive stress
  • abuse or neglect
  • trauma (physical and/or emotional)
  • loss of a parent, caregiver, or other loved one
  • loss of a relationship, such as moving away or loss of boyfriend/girlfriend
  • failure to accomplish tasks such as learning to read, or keeping up with peers in other activities
  • chronic illnesses, such as diabetes
  • other psychiatric disorders
  • other developmental, learning, or conduct disorders

There are biological, psychological, and social factors that can contribute to depression separately or in combination.

  • Depression is thought to be caused by a difference in the structure and function of your child’s brain that controls the intensity of sad or irritable moods.
  • There may be a genetic component. If other members of your family have had depression, your child is more likely to develop it, too.
  • A stressful environment at home, school, or in the community can contribute to depression.
  • Children may experience depression if they feels unhappy with their environment and powerless to make any change to it.
Low thyroid levels may sometimes cause fatigue, and other symptoms that may mimic symptoms of depression. Your child’s doctor can discuss this with you in more detail.

What’s the difference between depression and grief?

Grief is a normal and natural response to loss. While grief and depression share certain symptoms (e.g. sadness, too much or too little sleep, changes in eating patterns), grief is not as constant. In other words, a person who is grieving may feel very sad when thinking about or remembering the loss, but feel somewhat better around friends and family. But someone with depression rarely finds relief from sadness.

What are the risks of depression?

If you think your child might be depressed, have an evaluation sooner rather than later. If left untreated, depression could lead to:

  • failure in school
  • involvement in risky behaviors
  • difficulties with jobs and relationships in adulthood
  • attempted or successful suicide

How we care for children with depression

The Boston Children’s Hospital Department of Psychiatry and Behavioral Sciences has long been at the forefront of providing expert, compassionate care to children and adolescents with mental health issues. Our approach to mental health care is evidence-based — which means our treatments have been tested and proven effective through scientific studies, both here at our hospital and by other leading institutions worldwide. Boston Children’s has a dedicated Psychopharmacology Clinic to help determine whether medication might be a helpful addition to the treatment plan.

For children's that need hospitalization, Boston Children's Inpatient Psychiatry Service provides family oriented psychiatric assessment and treatment with the goal of returning your child to a more comfortable environment for ongoing care.