Depression affects more children and adolescents than was once believed. Just as in adults, depression in children and adolescents can range from mild to severe. Because "mood swings" and other emotional changes are considered a normal part of growing up, depression in children and adolescents often goes unrecognized. If left untreated, depression can greatly affect the quality of life both for the young person and his or her family and can lead to serious outcomes, including suicide attempts and death.

Some sadness, irritability, and feelings of depression in a child or adolescent are normal mood variations that are healthy and allow the young person to process grief or reassess life. Sadness (bereavement), for example, is appropriate when responding to a loss, such as the death of a family member or even a pet, loss of a friendship, or parents' divorce. If it is a severe loss, the child may remain sad for a longer period of time. However, when these emotions do not go away or begin to interfere with the young person's life, a sadness problem may result, and intervention may be necessary. If the situation becomes increasingly severe, either dysthymic disorder or major depressive disorder (depression) may be diagnosed.

Major depressive disorder (depression) in a child or adolescent is diagnosed when at least 5 of the following symptoms occur almost every day for at least 2 weeks:¹

• Feeling sad, irritable, or depressed
• Loss of pleasure or interest in almost all activities he or she once enjoyed
• Weight loss or weight gain, or failure to make expected weight gains in normal growth
• Sleeping too little or too much
• Body movements appearing to others as either restless or unusually slow
• Daily fatigue or loss of energy
• Feeling worthless
• Excessive or inappropriate guilt feelings nearly every day
• Difficulty with concentrating, thinking, or making decisions
• Repeated thoughts of death or suicide, or actually attempting suicide

Symptoms of depression are not a temporary response to a tragic event in the child's life (bereavement) or due to abuse of a substance such as alcohol or drugs. The symptoms must significantly impact the child's social life, schoolwork, or other important areas of life.

Childhood and adolescent depression is diagnosed in up to 2% of children and 8% of adolescents.^{2, 3} However, a recent study indicated that childhood and adolescent depression may be far more common. The study estimates that around 28% of young people will experience at least one major depressive episode by the time they reach 19 years of age.⁴

Depression occurs equally in boys and girls in preadolescence. However, between the ages of 14 to 18 years, girls are twice as likely to experience depression as boys.⁴ Depression lasts an average of 7 to 9 months in children and adolescents. Even with treatment, half of those children and adolescents with depression suffer a recurrence of the illness.²

Treatment for childhood and adolescent depression includes professional counseling (such as cognitive behavioral therapy), medications (such as fluoxetine), and family education. Usually, a combination of these treatments is needed for successful recovery from depression.² However, there is some controversy in treating children and adolescents with medications as the long-term results are not yet known. Sometimes a brief hospitalization may be required if the child or adolescent is experiencing suicidal thoughts or has additional mental or medical conditions.

Depression in children and adolescents often is accompanied by other difficulties that may include:

• Anxiety disorders.
• Disruptive behavior disorders.
• Substance abuse problems.
• Suicide attempts.

Suicide is the third leading cause of death for adolescents and young adults.⁵ The risk of suicide increases when depression goes unrecognized and untreated. Therefore, if you suspect your child or adolescent may have symptoms of depression, it is very important to let your health professional know so that your child can be evaluated. If you are a child or adolescent and think you may have depression, let your parent or another adult know right away, and try to remember that depression in people your age is not uncommon.