Reviewed by Rhonda C. Boyd, PhD, Jason A. Lewis, PhD, Angela T. Anderson, MD
Reviewed on 12/29/2025
What is major depression?
Major depression is a type of mood (or “affective”) disorder that goes far beyond the typical feelings of sadness that a child or adolescent might experience. It is a persistently sad or irritable mood that affects an individual’s thinking and behavior at home, in school and/or with peers.
The National Institute of Mental Health estimates that more than 10% of adolescents ages 12-17 experience major depression each year. It is on the rise in both children and adolescents. Depression in childhood and adolescence can predict future episodes of depression in 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.
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Narrator: As common as it is, depression tends to go unnoticed, especially in teenagers. You may not know it, but you probably have friends who are depressed. They don't seem depressed by how they act at school or what they post online, but what you see on social media or in real life are usually the things they want you to see.
That's because we would much rather show our best selves to the world, even if it means hiding our troubles. Let's back up. What is depression exactly? Depression is a mood disorder that is usually caused by a combination of genetics and environment. The causes of depression vary from person to person and a family history of depression, negative life events, racism, discrimination, substance use, and chronic illness are some factors that put you at higher risk.
What are the symptoms of depression? Perhaps you've lost interest in your favorite sports, can't focus on schoolwork or don't have the urge to eat. You might be in a good mood one moment and in a foul mood the next, or maybe you are getting along with someone just fine, but the next day they are getting on your nerves.
Or perhaps you are much more irritable than usual. Maybe there are periods when you feel almost normal, like when you're with friends, but the symptoms return behind closed doors. Ask yourself, have I experienced a drastic change in mood, interests, weight, appetite, sleep, concentration, or energy? Having symptoms doesn't always mean you have depression.
Three other factors play a role. The duration. How long have you been feeling this way? The frequency. How often do you feel this way. And the impact. How are these symptoms affecting your life? If your symptoms occur often or last long enough to interfere with your life, whether it's your grades, activities, or relationships, talk to your parents, caregivers, school counselor, or an adult you trust about how you're feeling.
Your family might not know about your problems unless you open up to them. If you or your family think you might be depressed, the only way to know for sure is to see your doctor as soon as possible. If you are having thoughts of death or self harm, tell someone right away. Please don't wait to get help.
Depression is not a bad word. When you ask for help, depression can be addressed and treated. And you can go back to feeling like yourself and doing things you enjoy. How can you treat depression? When you meet with your doctor, they will review your symptoms and talk about treatment options with you.
Depression looks different in different people, and treatment will vary depending on what you need. Depending on how you're feeling, they may recommend counseling, medication and or advise you to see a mental health professional to help guide your treatment, which may include therapy. There are a few different styles of therapy they may recommend.
Cognitive behavioral therapy, or CBT, is about learning skills to handle emotions, modify thought patterns, and shift behaviors. Interpersonal psychotherapy or IPT teaches you how to improve relationships through better communication. Family therapy helps to foster positive interactions between you and your family.
Supportive therapy offers ways to talk through problems and how to solve them. Some people need a combination of counseling, therapy, and medication. Treating depression is not one size fits all. So work with your family and doctor to find the treatment plan best for you. Remember, you are not alone. There are people out there who understand how you feel and how you can heal.
If you are considering suicide, you need to seek help right away. Tell your parent, caregiver, or trusted adult immediately. Go to the emergency room or mental health crisis center. Call or text nine eight eight to reach the suicide and crisis lifeline. With the right help, better days are within reach.
Please don't wait.
Causes of major depression
Many factors, including genetics and environmental and psychological factors, can cause depression. Research suggests that major depression has a strong genetic component given that the illness can be passed from one generation to the next. However, it’s important to note that children and adolescents don’t always develop depression simply because their parents have it. Many individuals develop depression even when there is no family history of illness. Children and adolescents are also more likely to develop depression if they experience environmental stress, such as abuse, neglect, trauma, discrimination, significant changes or losses, family and parental distress or significant peer conflict, such as bullying or romantic loss. In addition, children and adolescents with chronic medical illnesses or other behavioral health disorders, such as anxiety and substance abuse, are at risk of developing depression.
Signs and symptoms of major depression
The symptoms of major depression vary by individual. To be diagnosed with major depression, a child or adolescent 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, sad, empty, depressed or irritable
- Feeling worthless
- Sleeping more or less than usual
- Decreased energy or fatigue
- Others noticing changes in bodily movement (slower than usual or an inability to sit still)
- Difficulty concentrating and/or a decline in school performance
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 or adolescent suffers from major depression, talk to their pediatrician or seek out a mental health provider who specializes in treating children and adolescents. Depression can also occur alongside other behavioral health disorders, such as substance abuse or anxiety disorders. Diagnosing and treating depression can be very complex, and it is very important to find a highly trained professional, such as a pediatrician, licensed clinical social worker, or a child and adolescent psychologist or psychiatrist. An accurate diagnosis and early treatment are keys to success in managing major depression.
At Children’s Hospital of Philadelphia (CHOP), a specialist will perform a comprehensive psychiatric evaluation. The evaluation may assess:
- Your child or adolescent’s age, overall health and medical history
- Extent of their 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 depressive episodes. Without treatment, your child or adolescent’s depression could persist for longer and become increasingly 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 or adolescent’s symptoms and other factors. The treatment plan may include:
Evidence-based individual therapy
- Cognitive-behavioral therapy (CBT): This type of therapy will help your child or adolescent decrease depressive symptoms by changing distorted views of themself and the world, engage in activities that promote positive mood, and utilize effective problem-solving and coping skills.
- Interpersonal therapy: This type of therapy will help your child or adolescent decrease depressive symptoms by working through difficult relationship stressors and learning skills to improve communication, problem-solving and social interaction.
Family therapy
A parent or caregiver’s support is crucial in helping a child or adolescent learn to manage their mood and life. Family therapy can help parents and caregivers gain skills to better understand and respond to a child or adolescent’s emotional needs. It can also increase a sense of closeness among family members by reducing conflict and promoting open and supportive communication.
Medication
Antidepressant medication can be very effective in treating moderate to severe depression, especially when medication is combined with individual and/or family therapy.
Outlook for major depression
Most children and adolescents who receive early and effective treatment for major depression will improve and may even go on to experience a complete resolution of symptoms. Children and adolescents with more severe episodes of depression and those 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 individuals have a recurrent type of depression that can come and go over the course of their lifetime and will benefit from periodically re-engaging in treatment as symptoms arise.
Follow-up care
Depending on your child or adolescent’s personalized treatment plan, they 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 their progress and ensure continued well-being.
Resources to help
Major Depression in Children Resources
Child and Adolescent Psychiatry and Behavioral Sciences Resources
We have created resources to help you find answers to your questions about behavioral and mental health and to feel confident with the care you are providing your child.
