MDD: What Is It?

Depression is a psychiatric disorder that afflicts young people with chronic feelings of sadness or worthlessness—the defining characteristic of the disorder is that it robs a person of the capacity for pleasure. Unhappiness triggered by events is not uncommon in children, but it normally goes away when circumstances change. Children with depression don’t recover when events change; their dark mood and lack of interest in things they used to enjoy will persist.

Depression can interfere with all aspects of a child’s life, resulting in absences from school, trouble socializing with peers, and, in severe cases, thoughts of suicide. Depression is diagnosed when negative feelings, lack of interest in previous activities, and physical symptoms like fatigue and insomnia persist for at least 2 weeks. Onset is usually in adolescence, and it is diagnosed about twice as often in girls than in boys.

The DSM-5 guidelines for major depressive disorder have been changed to eliminate what was called the “bereavement exclusion,” which ruled out diagnoses of depression for 2 months after the death of a loved one. This was changed to reflect current thinking that bereavement is a process that commonly continues for 1 to 2 years, and that the death of a loved one can also trigger a major depressive episode, especially in people who have already experienced an episode of depression. Instead of ruling out these cases, the manual offers detailed guidelines to help clinicians distinguish between the pattern of emotions experienced during grieving and the symptoms of a major depressive episode.