Understanding Signs of Depression in Children and Teens

By Khrisan Gosai, MD
Elliot Behavioral Health Services

Children and teens go through many changes during this time both physical and psychological. Hormonal changes resulting from puberty and having to navigate their new social world can impact the mental health of a child. These changes, coupled with the classic image of the moody teenager, can make it a struggle for parents and caregivers to know which steps they should or should not take to help during these years. For instance, it’s normal for parents to ask, am I seeing typical moodiness or is it depression?

Many mental health disorders first present during adolescence, and approximately 20% of adolescents have a diagnosable mental health disorder. Though this statistic might sound alarming, it also means that there is an increased level of mental health literacy among the U.S. population, and with mental health literacy, kids can get into appropriate treatment quicker. So, what should parents look for if they are concerned?

The classic signs and symptoms of depression include:

Depressed mood

• Diminished loss of interest or pleasure in almost all activities
• Significant weight or appetite changes
• Trouble sleeping
• Speeding up or slowing down of muscle movement
• Loss of energy
• Low self-esteem
• Difficulty concentrating
• Recurring thoughts of death or dying, suicide
• Longstanding feelings of interpersonal rejection

To be clinically depressed, a child must be experiencing five or more of these symptoms above during the same two-week period and at least one of the symptoms should be either depressed mood or loss of interest or pleasure.

Not every teen will have all of the criteria, or they may have more subtle signs. It's not uncommon for teens to have been depressed for many months prior to being formally diagnosed by their primary care provider. Understanding some nuances about mood, loss of interest, and difficulty with sleep can help.

Mood swings

It’s common for parents and caregivers to talk about “mood swings” and ask themselves if they are normal or not. The normal emotional ups and downs that occur during a day are what we tend to call “Affect”, which is basically what an outsider can observe when someone is experiencing their emotions and feelings. Mood, on the other hand, is a more long-lasting emotion that colors our perception of the world. Another way to describe this is that Affect is like the “weather”; it fluctuates with changes in emotion when someone feels sad. Whereas mood is like the “climate”; it’s more pervasive and sustained over the course of days, or even weeks, when someone is depressed. If someone is feeling down for a few hours or if they get back to feeling better again after a night’s sleep, it tends to point away from what I consider depression, but it’s also a good idea to track your child’s mood over the course of a few weeks if there are concerns.

Little interest or pleasure in doing things

“When was the last time you felt happy?” is a question often ask during initial evaluations with teens. You might find that someone is going through an episode of depression and initially starting to lose interest in previous activities such as drawing or hanging out with friends or not being as excited about future activities as they might have been before.

This appears different from the normal shifting of likes and dislikes that kids can have as they develop their interests. The difference is that the child is withdrawing from interests as opposed to expanding and exploring new things to do.

Trouble falling asleep, staying asleep, or sleeping too much

Research shows that teen sleep deprivation is commonly linked to depression, anxiety, and substance abuse, although it can be hard to figure out the chicken and egg connection between sleep and depression. It is worth seeing if there has been a change in sleep due to the environment. This can include bedtime practices or the increase in extracurricular activities and academic work.

According to the American Academy of Sleep Medicine, teens ages 13 to 18 should sleep around eight to 10 hours per day. Shifts in their body’s internal clock, which is common in teens, typically causes them to stay up late, which is unfortunately at odds with the early start times of their school days. If your child is getting enough sleep but still seems tired all the time or just doesn’t want to get out of bed, this could be a sign of depression.

Depression is a concerning, and important topic. The good news is that with proper treatment and support, teens and children can have control over their depression.

If you have concerns related to signs of depression from a teen or child in your life, please contact a trusted physician who can provide guidance.