Depression at Different Ages
How depression can present differently for kids and teenagers
Clinical Expert: David Friedlander, PsyD
What You'll Learn
- How does depression look different in children, teens, and adults?
- How can parents help their kids deal with depression?
Depression can affect people of any age, but it can be confusing because it often looks different in children, teens, and adults. Depression is typically characterized by feeling sad, empty, or hopeless most of the day, nearly every day. For kids and teens, however, irritability can replace sadness.
The biggest thing to look for in kids is a change in behavior — It’s not just that the child is cranky or down, but that those behaviors are not typical for that child. For children, the change could be a heightened sensitivity to criticism, withdrawal from activities they used to enjoy, and somatic complaints like stomachaches and headaches. In teenagers, social isolation, poor school performance, substance abuse, and self-harm can be symptoms of depression.
If you hear your child talking about attempting suicide, it’s important to talk to them. Depression is treatable, with cognitive behavioral therapy (CBT) being the most common and evidence-based treatment. Medications may also be used in combination with therapy.
Depression can affect people of any age, but it can be confusing because it often looks different in children, teens, and adults. And since teens are already prone to moodiness, it can be especially hard to tell if they are struggling with depression.
Knowing the signs of depression and how they differ across age ranges can better equip you to get your child help if they need it.
Symptoms of depression
For a person of any age, a diagnosis of depression is typically based on feeling sad, empty, or hopeless most of the day, nearly every day. Other common symptoms include diminished interest in activities they once enjoyed, eating more or less than usual, not sleeping enough or too much, withdrawing from friends and family, and having thoughts of suicide.
For kids and teens, however, irritability can replace sadness. If your child is unusually irritable for no reason, that could be a sign of depression. But it’s more about changes in their behavior than the symptoms themselves.
Depression in young children and pre-teens
The key is spotting depression in young kids is to look for a change in behavior, explains David Friedlander, PsyD, a clinical psychologist at the Child Mind Institute. It’s not just that the child is cranky or down but that those behaviors are not typical for that child.
Say your child used to put their homework neatly in a folder in their backpack, and now it’s crumpled in a ball at the bottom of the bag. Maybe they’re suddenly getting into fights or breaking rules in school when they’ve never done that before. Also, a heightened sensitivity to mistakes or criticism, like crying over getting an answer wrong when they used to shrug it off, can be a sign of depression.
Withdrawing from things they used to enjoy is a telltale sign of depression. Young kids rely heavily on their parents to get them to and from activities. So, withdrawal in young kids can look like asking to skip dance class repeatedly or telling their parents not to sign them up for sports anymore.
If kids frequently say something like, “I don’t want to,” or “I can’t,” it could signify that they are struggling with depression, “especially if you’re dealing with a kid who used to have joy for life and age-appropriate participation in activities,” Dr. Friedlander says.
Another sign of depression is sudden and frequent somatic complaints that weren’t there before, like stomachaches and headaches. Stomachaches generally don’t mean your child is depressed, but suddenly having a lot of stomachaches when they didn’t before might.
If your child is unusually irritable for no reason, even without sadness, that could be a sign of depression. However, there’s also a related mood disorder that’s sometimes diagnosed in extremely irritable kids called disruptive mood dysregulation disorder, which presents as extreme tantrums combined with irritability.
Depression in teenagers
Teenagers are notoriously moody, and often their mood swings aren’t a cause for concern. But if your teenager is much more irritable than they used to be, it could also be a sign of depression. “That’s really the key differentiator,” Dr. Friedlander says. “Teens are sometimes going to be irritable, but if they’re irritable most of the day, nearly every day, that’s one of the criteria for depression.”
As in younger children, social isolation is a major sign of depression in teens. Social isolation and attempts to withdraw can be more than just staying in their room. If they are usually with their friends after school but suddenly start coming home right after, it’s worth talking to them about it. While it’s not unusual for teens to have problems with friends, if your child says, “I’m not friends with so-and-so anymore,” you may want to ask about it.
Another change in behavior to look for in teens is school performance. If they’re suddenly getting D’s and F’s when they used to get good grades, and they’re blaming fatigue or an inability to concentrate, it might be a sign of depression.
Another thing to worry about in teens is self-harm; the most common form is cutting. Teens may cut because they are in intense distress, and the cutting makes them stop ruminating on whatever upsets them.
The most serious thing to look for is if your child is thinking about or attempting suicide. If you hear your child talking about dying, wishing they could disappear, or hurting themselves, it’s important to take it seriously and have an open and honest conversation about what’s happening. Though parents often worry that talking about suicide will make the problem worse, in fact, the evidence is clear that it helps kids to express their feelings, and it gives you an important opportunity to gauge whether they are at risk of hurting themselves and should be taken to the emergency room.
Substance abuse may also be a symptom of depression in teens. Dr. Friedlander notes that parents would have to determine the purpose of the substance use to find out if it’s linked to depression. What is your teen trying to achieve by smoking or drinking? What are they trying to avoid? “Anhedonia, the inability to experience pleasure, is a symptom of depression,” Dr. Friedlander explains. “If being high is the only way the child can have fun, that’s a sign they may be depressed.”
How parents can help with treatment
Depression is treatable. The most common, evidence-based treatment for depression is cognitive behavioral therapy (CBT), which teaches kids to notice and challenge negative, destructive thought patterns. There are several forms of CBT adapted for children and teenagers with depression, including DBT and IPT.
Medications are also used, sometimes in combination with therapy. The most frequently used antidepressant medications include SSRIs (selective serotonin reuptake inhibitors), like Zoloft, Prozac, and Lexapro, and SNRIs (serotonin-norepinephrine reuptake inhibitors), like Strattera and Cymbalta.
When it comes to treating younger kids, the parents usually need to be involved more. Parents of an eight-year-old, for example, will need to help schedule activities, make sure the child attends them, and provide incentives to continue completing the activities. With teens, parents’ involvement in the treatment of their depression varies. “Some are motivated enough to follow through on a treatment regimen with minimal support and prefer privacy over involving their parents,” Dr. Friedlander notes. Others need more support or incentives.
If you think your child or teenager is suicidal, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 or 911 if there is an emergency. Don’t wait — the risk of suicide in children and teenagers is very real.