Major Depression in Children

What is major depression?

A type of mood (or “affective”) disorder, major depression, goes far beyond the typical feelings of sadness that a child might experience. Instead, major depression is a persistently sad or irritable mood that affects a child’s thinking and behavior at home, in school, and with peers.

The National Institute of Mental Health estimates that more than 10 percent of adolescents ages 12-17 experience major depression in a given year. It is on the rise in both children and adolescents. With early onset, childhood and adolescence depression can predict future episodes of depression into adulthood. Early and consistent treatment can help to lessen the risk of recurrence and reduce the severity of symptoms while improving functioning and well-being.  

Causes of major depression

There are a combination of causes, such as genetics, environment, and psychological factors.  Research suggests that major depression has a strong genetic component given that the illness can be passed on from one generation to the next.  However, it’s important to note that children don’t always develop depression simply because their parents have it. Many children develop depression even when there is no family history of the illness.  Children are also more likely to develop depression if they experience environmental stress such as abuse, neglect, or trauma, significant changes or losses, family and parental distress, or significant peer conflict such as bullying or romantic loss. In addition, children with chronic medical illnesses or other behavioral health disorders, such as anxiety, are at risk for developing depression.  

Signs and Symptoms of major depression

Each child may experience symptoms of major depression differently. To be diagnosed with major depression, a child needs to show at least one of the following two symptoms for most days of the week, for most of the day, during the same two-week period:

  • Persistent feelings of sadness or irritability

  • Loss of interest or pleasure in all or almost all activities once enjoyed

In addition, several of the following symptoms must also be present:

  • Feeling hopeless or helpless

  • Having low self-esteem

  • Feeling inadequate

  • Excessive guilt

  • Difficulty with relationships or social withdrawal

  • Sleep disturbances, whether sleeping too much or too little

  • Changes in appetite or weight

  • Decreased energy

  • Difficulty concentrating or a decline in school performance

  • Increased sensitivity to failure or rejection

  • Indecision

  • Frequent physical complaints, such as a headache, stomachache, or fatigue

  • Thoughts of wishing to be dead

  • Suicidal thoughts or attempts

It’s crucial to remember that depression symptoms and suicidal thoughts and behaviors must be taken very seriously. 

Testing and Diagnosis of major depression

If you believe your child suffers from major depression, talk to your child’s pediatrician or seek out either a therapist or psychiatrist who specializes in children and adolescents. An accurate diagnosis and early treatment are keys to success in managing major depression. Depression can also occur alongside other behavioral health disorders, such as substance abuse or anxiety disorders. With the level of complexity often involved in diagnosing and treating depression, finding a highly trained professional, such as a pediatrician, licensed clinical social worker, a child psychologist, or a child and adolescent psychiatrist, is important.

At Children’s Hospital of Philadelphia, a specialist will perform a comprehensive psychiatric evaluation. The evaluation may assess

  • Your child's age, overall health, and medical history

  • Extent of your child's current symptoms, behaviors, and functioning

  • Expectations for the course of the condition

  • Family dynamics and environmental stressors

  • Family psychiatric and medical history

  • Input from teachers and other care providers

Treatment for major depression

Early treatment is key to reducing distress, improving functioning, and preventing future depression episodes. Without treatment, your child’s depression could persist for longer and become increasingly more severe, leading to significant impairment in school, at home, and with friends and family.

At Children’s Hospital of Philadelphia, a specialist will design an individualized treatment plan based on your child’s symptoms and other personal factors. The treatment plan may include:

Evidence-based Individual Therapy

  • Cognitive-behavioral therapy: This treatment will help your child decrease depressive symptoms by changing distorted views of himself/herself and the world, engage in activities that promote positive mood, and utilize effective problem solving and coping skills.

  • Interpersonal therapy: This treatment will help your child decrease depressive symptoms by having him/her cope with and work through difficult relationship stressors by learning skills to improve communication, problem solving, and social interaction.

Family Therapy

A parent’s support is crucial in helping a child learn to manage his/her mood and life. Family therapy can also explore and address family dynamics or situational stressors contributing to your child’s depression.


An antidepressant medication can be very effective in treating moderate to severe depression, especially when it’s combined with individual and/or family therapy.

Outlook for major depression

Most children who receive early and effective treatment for major depression will improve and may even go on to experience complete resolution of symptoms. Children with more severe episodes of depression and children who have depression as well as other disorders (such as substance use, anxiety, or emotional dysregulation) may continue to work with treatment providers for a longer period of time. Some children will have a recurrent type of depression that can come and go over the course of their lifetime.  These children benefit from periodically re-engaging in treatment as symptoms arise.

Follow-Up Care

Depending on your child’s personalized treatment plan, your child and family may continue to meet with treatment providers until the symptoms of depression are in remission or under good control.  Periodic follow-up visits may be advised to monitor your child’s progress and ensure continued well-being.

Why Choose CHOP

An accurate diagnosis and early treatment are critical to helping a child recover from major depression and prevent later episodes. Treatment also allows your child to flourish at home, school, and in their relationships. Your child would be able to function at his/her best without depression interfering with his/her thoughts, feelings, and behavior. The team at Children’s Hospital of Philadelphia is specially trained to diagnose, treat, and manage major depression in children and adolescents. They have the skill set and experience to lead your child to long-term success.

Reviewed by Rhonda C. Boyd, PhD, Jason A. Lewis, PhD