Depression is a common mental health condition that causes someone to be in a sad or irritable mood for an unusually long period of time. It’s normal for children to feel down when bad things happen, but a child with depression doesn’t feel better if things change. Children and teenagers who are depressed usually have trouble enjoying things they used to love and have low energy. They might think about or attempt suicide.
Depression usually begins during the teenage years, but younger kids can also be diagnosed. Girls are diagnosed twice as often as boys.
Depression can take a number of different forms. The disorders below are all forms of what experts call “unipolar depression.” The term “unipolar” is used to distinguish them from bipolar depression, which involves a combination of extreme lows and highs — episodes of depression alternating with episodes of mania — and is treated differently from other forms of depression.
Major Depressive Disorder
This is the most familiar kind of depression, in which someone experiences severe symptoms that last between two weeks and several months. An episode of depression may occur only once, but in most cases the depression will return multiple times.
The biggest sign of depression is a change in mood. A depressed child will feel sad or irritable —quick to anger over very small things — most of the time, and lose interest in things they normally enjoy.
Other symptoms include:
- Feeling hopeless
- Lacking energy or being tired all the time
- Trouble concentrating
- Poor performance or poor attendance at school
- Low self-esteem or saying negative things about themselves
- Eating too little or too much
- Gaining or losing a lot of weight
- Trouble sleeping
- Thinking about or attempting suicide
Some children with depression no longer look forward to things they used to enjoy, but they can enjoy them in the moment. This is unusual and is known as atypical depression. It can trick parents, making them think their child doesn’t want to cooperate when they are actually depressed.
Persistent Depressive Disorder (Dysthymia)
This is a form of depression in which someone experiences the same symptoms as major depressive disorder, but in a milder form. And instead of occurring in episodes of several weeks or months, the symptoms last for a year or more. In persistent depressive disorder, the symptoms may get more or less severe at different times, but they don’t go away for more than two months at a time.
Since the symptoms of persistent depressive disorder can last for years, it can appear that a downbeat mood, low self-esteem or irritability is just a part of a child or teenager’s personality. But treatment can make a big difference.
Disruptive Mood Dysregulation Disorder (DMDD)
DMDD is a relatively new diagnosis that is given to children who have frequent, explosive temper tantrums in reaction to things that don’t seem like a big deal. In between tantrums they are irritable most of the time. They have a short fuse, and low frustration tolerance. The DMDD diagnosis recognizes that for young children, depression can look more like anger than sadness.
Symptoms of DMDD usually show up before age 10. It is not diagnosed before age six because temper tantrums are normal for young kids. To be diagnosed with DMDD a child must have major temper tantrums three or more times a week on average. This behavior has to show up when the child is with family, friends and teachers— if it’s only in one situation it’s probably not DMDD.
Unlike kids with oppositional defiant disorder (ODD) these kids aren’t focused on defying authority. They act out because they experience feelings more powerfully than other kids, and they lack self-regulation skills.
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual dysphoric disorder is a condition that affects some women and girls in the week before their period, when hormones spike. Symptoms are similar to PMS but so severe that they have a serious impact on daily life. While PMS may be troubling, a girl with PMDD is likely to experience feelings closer to a major depressive episode.
Girls with PMDD might feel depressed, anxious or angry. They may cry for little or no reason. They may also have trouble concentrating and staying on task. They may feel overwhelmed, and worried that everyone is mad or unhappy with them. Physical symptoms like cramps, headaches, body aches and tender breasts are common.
Symptoms typically start 5–8 days before their period but can begin earlier, and they go away once the period begins. Onset of PMDD can be any time after puberty.
Seasonal Affective Disorder (SAD)
Seasonal affective disorder (SAD) is a type of depression that comes and goes with changes of seasons. It has all the same symptoms as major depressive disorder, but it only happens during specific months of the year. The technical name for it is “major depressive disorder with seasonal pattern.”
Most people who experience seasonal affective disorder get depressed in the fall and winter — possibly because getting less sunlight in the winter affects brain chemicals that impact mood and energy levels. But for some people, depressive episodes are triggered by summer.
To be considered signs of SAD, the symptoms can’t be related to something that happens during the time period when they appear, such as events at home or school during the winter.
Treatment for depression
Many clinicians recommend that if a child is taking antidepressant medication they should also be participating in therapy. Medication can reduce symptoms of depression, but therapy teaches kids skills to manage their moods and cope in a healthy way with uncomfortable feelings.