Depression in children

Last reviewed: 1 Sep 2023
Last updated: 01 Mar 2023



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
More key diagnostic factors

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
Other diagnostic factors

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/misuse
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations 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
More investigations to consider

Treatment algorithm


at risk of self-harm



moderate or severe


following stabilization of acute symptoms



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




PH declares that he has no competing interests.

Khrista Boylan, MD, PhD, FRCPC

Associate Professor

Psychiatry and Behavioural Neurosciences

McMaster University




KB declares that she has no competing interests.


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.


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.

Peer reviewers

Richa Bhatia, MD

Director of Psychiatry

Santa Rosa Community Health



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




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



PJvW declares that he has no competing interests.

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