Depression in children

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 3 Feb 2026

Last updated: 19 Feb 2026

Depression in children is characterized by sad or irritable mood, anhedonia, decreased capacity to have fun, decreased self-esteem, sleep disturbance, social withdrawal or impaired social relationships, and impaired school performance. Depression may be chronic or recurring, is a leading cause of disability among children, and can lead to death by suicide.

At-risk children should be screened for depression. It is crucial to make an accurate diagnosis, based on a comprehensive assessment and review of the history, with input from multiple sources.

The safety of the child and others, and the duration and severity of depression, need to be evaluated carefully to help determine the appropriate level of care and treatment modality. Suicidality needs to be assessed at each healthcare encounter.

Treatment is typically with active monitoring, specific psychotherapies, antidepressants, or a combination of these therapies.

Following recovery, relapse or recurrence rate is high in the absence of continuation treatment.

Definition

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) categorizes depressive disorders into the following categories: major depressive disorder (MDD), persistent depressive disorder, disruptive mood dysregulation disorder, premenstrual dysphoric disorder, substance/drug-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder.[1] This topic focuses on MDD and persistent depressive disorder. MDD in children is typically more severe than persistent depressive disorder, and is characterized by at least 5 depressive symptoms, with 3 levels of severity: mild, moderate, and severe. Persistent depressive disorder is a chronic form of depressive disorder, which is characterized by a sad or irritable mood, lasting for at least 1 year, with 2 or more additional depressive symptoms.

História e exame físico

Principais fatores diagnósticos

sad and/or irritable mood
decreased interest or lack of enjoyment
significant functional impairment
no evidence of a manic or hypomanic episode
no history of recent bereavement

Detalhes completos

Outros fatores diagnósticos

decreased concentration or indecision
insomnia or hypersomnia
change of appetite or weight
excessive fatigue
feelings of worthlessness or excessive guilt
feelings of hopelessness
psychomotor agitation or retardation
somatic complaints
social withdrawal or change of friends
recurrent thoughts of death or suicidal ideation and self-harm
increased substance use

Detalhes completos

Fatores de risco

positive family history of depression
other parental psychopathology
personal history of other psychiatric disorders (e.g., anxiety)
stress or trauma
female sex
sexual minority status
personal history of chronic medical illness
postpartum status
neighborhood and social instability
immunosuppressive drugs (e.g., corticosteroids, interferon)
substance use problems/disorders
sedentary behavior
screen time

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis

Detalhes completos

Investigações a serem consideradas

serum thyroid-stimulating hormone (TSH) and free thyroxine (T4)
complete blood count with differential
urine drug screen
urine pregnancy test
serum B12 and folate
vitamin D level

Detalhes completos

Algoritmo de tratamento

Inicial

at risk of suicidality

AGUDA

mild

moderate or severe

CONTÍNUA

following stabilization of acute symptoms

Colaboradores

Autores

Philip Hazell, BMedSc, MBChB, PhD, FRANZCP, Cert Accred Child Psychiatry (RANZCP)

Honorary Professor

Specialty of Psychiatry, School of Medicine

The University of Sydney

Sydney

Australia

Clinical Professor

School of Medicine, Faculty of Health

Charles Darwin University

Darwin

Australia

Declarações

PH declares that he has no competing interests.

Khrista Boylan, MD, PhD, FRCPC

Associate Professor

Psychiatry and Behavioural Neurosciences

McMaster University

Hamilton

Canada

Declarações

KB declares that she has no competing interests.

Agradecimentos

Professor Philip Hazell and Dr Khrista Boylan would like to gratefully acknowledge Dr Lisa Pan, Dr David A. Brent, Dr Rongrong Tao, Dr Graham Emslie, and Dr Taryn Mayes, the previous contributors to this topic.

Declarações

LP declares that she has no competing interests. DAB receives royalties from Guilford Press; has received or will receive royalties from the electronic self-rated version of the C-SSRS from ERT, Inc; is on the editorial board of UpToDate; is a reviewer for Healthwise; and is on the board of the Klingenstein Foundation. RT is an author of a number of references cited in this topic. GE has received research funds from BioMarin, Eli Lilly, Forest Laboratories, GlaxoSmithKline, and Somerset; has served as a consultant for Biobehavioral Diagnostic Company, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, INC Research Inc., Lundbeck, Pfizer Inc., Seaside Therapeutics, Shire Pharmaceuticals, Valeant, Validus Pharmaceuticals, and Wyeth Ayerst; and has been on the speaker's bureau for Forest Laboratories. TM is an author of a number of references cited in this topic.

Revisores

Shannon Barnett, MD, MBE

Assistant Professor of Psychiatry and Behavioral Sciences

The Johns Hopkins University School of Medicine

Baltimore

Declarações

SB declares that she has no competing interests.

Richa Bhatia, MD

Director of Psychiatry

Santa Rosa Community Health

Declarações

RB declares that he has no competing interests.

Paramala J. Santosh, MBBS, DipNB (Psych), MRCPsych, MD

Honorary Senior Lecturer

Institute of Child Health and Institute of Psychiatry

Consultant in Child and Adolescent Neuropsychiatry and Psychopharmacology

Head of Centre for Interventional Paediatric Psychopharmacology

Department of Child & Adolescent Mental Health

Great Ormond Street Hospital for Children

London

Declarações

PJS declares that he has no competing interests.

Pieter Joost van Wattum, MD, MA

Assistant Clinical Professor of Child Psychiatry

Yale School of Medicine

Medical Director of Psychiatry

Clifford W. Beers Guidance Clinic

New Haven

Declarações

PJvW declares that he has no competing interests.

Créditos aos pareceristas

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Referências

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Principais artigos

Zuckerbrot RA, Cheung A, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018 Mar;141(3):e20174081.Texto completo Resumo

Hua LL, Lee J, Rahmandar MH, et al. Suicide and suicide risk in adolescents. Pediatrics. 2024 Jan 1;153(1):e2023064800.Texto completo Resumo

Walter HJ, Abright AR, Bukstein OG, et al. Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders. J Am Acad Child Adolesc Psychiatry. 21Oct 2022 [Epub ahead of print].Texto completo Resumo

National Institute for Health and Care Excellence. Depression in children and young people: identification and management. Jun 2019 [internet publication].Texto completo

Cheung AH, Zuckerbrot RA, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics. 2018 Mar;141(3):e20174082.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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Depression in children

Summary

Definition

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

at risk of suicidality

mild

moderate or severe

following stabilization of acute symptoms

Colaboradores

Autores

Philip Hazell, BMedSc, MBChB, PhD, FRANZCP, Cert Accred Child Psychiatry (RANZCP)

Declarações

Khrista Boylan, MD, PhD, FRCPC

Declarações

Agradecimentos

Declarações

Revisores

Shannon Barnett, MD, MBE

Declarações

Richa Bhatia, MD

Declarações

Paramala J. Santosh, MBBS, DipNB (Psych), MRCPsych, MD

Declarações

Pieter Joost van Wattum, MD, MA

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice