Depression in children

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

Last reviewed: 25 Nov 2025

Last updated: 22 Feb 2024

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.

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

There is an increased risk for school disengagement, substance use disorders, suicide attempts, and completed suicide. Suicidality needs to be assessed at each healthcare encounter.

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/medication-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 a more severe form of 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 more chronic form of depressive disorder, which is characterized by a chronic sad or irritable mood, lasting for at least 1 year, with 2 or more additional depressive symptoms.

History and exam

Key diagnostic factors

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

Full details

Other diagnostic factors

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

Full details

Risk factors

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 medications (e.g., corticosteroids, interferon)
substance use problems/disorders

Full details

Diagnostic tests

1st tests to order

clinical diagnosis

Full details

Tests to consider

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

Full details

Treatment algorithm

INITIAL

at risk of suicidality

ACUTE

mild

moderate or severe

ONGOING

following stabilization of acute symptoms

Contributors

Authors

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

Conjoint Professor of Child and Adolescent Psychiatry

Specialty of Psychiatry, School of Medicine

University of Sydney

Sydney

Australia

Disclosures

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

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

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

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

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

Locher C, Koechlin H, Zion SR, et al. Efficacy and safety of selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and placebo for common psychiatric disorders among children and adolescents: a systematic review and meta-analysis. JAMA Psychiatry. 2017 Oct 1;74(10):1011-20.Texto completo Resumo

Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA. 2008 Feb 27;299(8):901-13.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.

Diagnósticos diferenciais
- Bipolar disorder
- Anxiety disorder
- ADHD
Mais Diagnósticos diferenciais
Diretrizes
- Screening for depression in children and adolescents: recommendation statement
- Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders
Mais Diretrizes
Folhetos informativos para os pacientes
Depression in children and teenagers: what is it?
Depression in children and teenagers: what are the treatment options?
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

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Depression in children

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

at risk of suicidality

mild

moderate or severe

following stabilization of acute symptoms

Contributors

Authors

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

Disclosures

Khrista Boylan, MD, PhD, FRCPC

Declarações

Agradecimentos

Declarações

Revisores

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

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice