Depression can have a lot of negative effects on an individual’s life, such as missing school and not wanting to be around friends. It is typical for children and adolescents to feel sad when bad things happen, but a child or adolescent with depression doesn’t feel better if things change. Children and adolescents with depression might be at risk of thinking about or attempting suicide.

What are the symptoms of Depression?

The biggest sign of depression is a change in mood. A depressed child or adolescent feels sad for no reason and may lose interest in things they normally enjoy. Specific symptoms include:

Core Symptoms

Associated Symptoms

  • Depressed or irritated mood most of the day nearly every day for two weeks or more
  • Reduced or loss of interest or pleasure in activities most of the day nearly every day for two weeks or more
  • Notable appetite changes, weight gain, or weight loss
  • Sleep difficulties
  • Fatigue or loss of energy
  • Worthless feelings or excessive guilt
  • Concentration difficulties
  • Recurrent thoughts about death, thinking about or attempting suicide
  • Being easily annoyed
  • Feeling hopeless
  • Seeming lazy
  • Difficulty making decisions
  • Struggling in school
  • Low self-esteem or saying negative things about themselves
  • Having trouble talking to friends

Depression presents in what we call episodes, meaning that a child or adolescent that is depressed is unlikely to be depressed for their whole life, but rather for a period.

What is Dysthymia and how is it different from Depression?

When a child or adolescent goes through recurrent depressive episodes, they most likely have Persistent Depressive Disorder or Dysthymia. Dysthymia is similar to Depression, although there are several important differences. For Dysthymia to be diagnosed, a child’s or teen’s symptoms must be present for most of the day, more often than not, for at least one year, and they must not be without symptoms for more than two months at a time. When depressed, at least two of the following symptoms must be present:

  • Overeating or poor appetite;
  • Hypersomnia or insomnia;
  • Fatigue or lack of energy;
  • Poor self-esteem;
  • Poor concentration or decision making; or
  • Feelings of hopelessness.

How are Depression and Dysthymia diagnosed?

A child-adolescent psychiatrist will diagnose a child or teen with Depression or Dysthymia after determining whether his or her mood change and/or other symptoms meet the diagnostic criteria; his or her symptoms have lasted at least two weeks, or one year in the case of Dysthymia; and his or her symptoms result in significant impairment in other aspects of everyday life (e.g., social, academic, etc.).

The child-adolescent psychiatrist may interview and/or assess both the child and a caregiver in order to determine the specific nature of the child’s depressed mood, although many practitioners also use behavior and emotion rating form results to support the diagnosis. The practitioner will also seek to determine that the child’s or teen’s mood change or persistent depressed mood is not related to something unforeseen.

Depression and Dysthymia Facts

Worldwide frequency of the conditions

According to recent data, Depression and Dysthymia are estimated to be present in 8% and 4% of adolescents, respectively. Across the lifespan these conditions are estimated to be present in between 2.6 to 4.1% of the world’s population, and 1.7% of the European population. Estimates created based on data collected during the COVID-19 pandemic are elevated.

Burden of the condition in Greece

Depression accounts for 5.2% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents. It is the 3rd most prominent mental health condition adding to the health burden of the Greek child and adolescent population.

Gender ratio

Male-female comparative data for Depression varies widely based on the severity and the broad range of co-occurring disorders. Generally, females are more likely to be diagnosed than males at a rate of 2:1.

Peak age of onset

The peak age of onset for Depression is estimated to be 19.5 years, while the peak age of onset for mood disorders, in general, including Dysthymia, is 20.5 years.

Proportion of the condition that emerges before age 18

According to recent data, 13.7% of individuals with Depression will have been diagnosed by the time they are 18 years old. This is similar to mood disorders, in general, including Dysthymia, where 11.5% of individuals will have been diagnosed by 18 years of age.

What are the associated factors for Depression and Dysthymia?

Some common factors associated with Depression and Dysthymia are:

  • Genetic and familial factors. Most likely a combination of multiple genes that interact in a complex way with multiple environmental factors.
  • Environmental factors. These include adverse and stressful life events (e.g., maltreatment during childhood, loss of a parent), chronic diseases, as well as social challenges (e.g., family income, educational experience, racism).
  • Temperament. A proneness toward feeling anxious and concerns about being harmed.
  • Other health problems. These include chronic or debilitating illness (e.g., diabetes, significant physical injury).

What other disorders co-occur with Depression and Dysthymia?

Even though each child and adolescent is different, Depression and Dysthymia might commonly co-occur with anxiety disorders (e.g., Generalized Anxiety Disorder [GAD], Separation Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, etc.), substance-use disorders, Obsessive-Compulsive Disorder [OCD], and eating disorders.

How are Depression and Dysthymia treated?

Many young patients with mild depression respond to assessment and psychoeducation alone. For moderate-to-severe depression, the best treatment is a combination of psychotherapy and medication. Caregivers and other family members are sometimes involved in treatment to learn about the ways that their relationships may play a role in their child’s or adolescent’s mood, and to help them practice the skills they learn in therapy

There are multiple therapies that have been shown to effectively treat symptoms of Depression, but there are two with more support than others:

  • Interpersonal therapy (IPT) decreases interpersonal conflicts by teaching interpersonal problem-solving skills and helping to modify dysfunctional communication and relational patterns and involves the child or teen speaking with a therapist about relationships with friends and family. They learn how these relationships cause good or bad feelings.
  • Cognitive-behavioral therapy (CBT), which teaches children and adolescents how their thoughts shape their feelings and behaviors. During therapy, the therapist will encourage the child or teen to return to activities they enjoyed in the past, which is referred to as “behavioral activation.” Other CBT techniques include learning more effective “problem solving” and strategies that enhance “emotion regulation.” Group-based CBT has been shown to be particularly effective for children and adolescents.
  • Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), alone or in combination with CBT, is the only medication with sufficient evidence for use to treat Depression in children and adolescents. Other SSRIs (e.g., sertraline, paroxetine, citalopram, escitalopram) have been studied and might be used, but have less evidence that they work. Medications can have side effects, but they are safe for children to use with proper care from their doctor. A child or teen who is taking one of these medications should see their doctor regularly, especially if their dosage has recently.

Where to find more information

If you need more information on persistent sadness and reasons for concerns, you can also go to "Persistent sadness" on our website

To learn more about the technical work conducted to develop this guide, please consult our reference list:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Child Mind Institute. (2021, September 7). Quick guide to depression. https://childmind.org/guide/depression-in-kids-quick-guide/
  • Miller, C. (2022, December 6). What are the kinds of depression? https://childmind.org/article/what-are-the-kinds-of-depression/
  • Steingard, R. J. (2022, October 28). What are the symptoms of Depression in teenagers? https://childmind.org/article/what-are-the-symptoms-of-depression-in-teenagers/
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. Depressive Disorders. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1563440232
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6A70 Single Episode Depressive Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f57863557402/2022
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6A71 Recurrent Depressive Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1194756772
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6A72 Dysthymic Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f810797047

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Global Burden of Disease Collaborative Network. (2020). Global Burden of Disease Study 2019 (GBD 2019) Results. Institute for Health Metrics and Evaluation (IHME). https://vizhub.healthdata.org/gbd-results/
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365. https://doi.org/10.1111/jcpp.12381
  • Sacco, R., Camilleri, N., Eberhardt, J., Umla-Runge, K., & Newbury-Birch, D. (2022). A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-02131-2
  • Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102
  • Shorey, S., Ng, E. D., & Wong, C. H. J. (2022). Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta‐analysis. British Journal of Clinical Psychology, 61(2), 287–305. https://doi.org/10.1111/bjc.12333
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Arango, C., Dragioti, E., Solmi, M., Cortese, S., Domschke, K., Murray, R. M., Jones, P. B., Uher, R., Carvalho, A. F., Reichenberg, A., Shin, J. I., Andreassen, O. A., Correll, C. U., & Fusar‐Poli, P. (2021). Risk and protective factors for mental disorders beyond genetics: An evidence‐based atlas. World Psychiatry, 20(3), 417–436. https://doi.org/10.1002/wps.20894
  • Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Frontiers in Psychology, 10, 543. https://doi.org/10.3389/fpsyg.2019.00543
  • Gardner, M. J., Thomas, H. J., & Erskine, H. E. (2019). The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis. Child Abuse & Neglect, 96, 104082. https://doi.org/10.1016/j.chiabu.2019.104082
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Kwong, A. S. F., López-López, J. A., Hammerton, G., Manley, D., Timpson, N. J., Leckie, G., & Pearson, R. M. (2019). Genetic and Environmental Risk Factors Associated With Trajectories of Depression Symptoms From Adolescence to Young Adulthood. JAMA Network Open, 2(6), e196587. https://doi.org/10.1001/jamanetworkopen.2019.6587
  • Stirling, K., Toumbourou, J. W., & Rowland, B. (2015). Community factors influencing child and adolescent depression: A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 49(10), 869–886. https://doi.org/10.1177/0004867415603129
  • Zajkowska, Z., Walsh, A., Zonca, V., Gullett, N., Pedersen, G. A., Kieling, C., Swartz, J. R., Karmacharya, R., Fisher, H. L., Kohrt, B. A., & Mondelli, V. (2021). A systematic review of the association between biological markers and environmental stress risk factors for adolescent depression. Journal of Psychiatric Research, 138, 163–175. https://doi.org/10.1016/j.jpsychires.2021.04.003
  • Zheng, K., Abraham, C., Bruzzese, J.-M., & Smaldone, A. (2020). Longitudinal Relationships Between Depression and Chronic Illness in Adolescents: An Integrative Review. Journal of Pediatric Health Care, 34(4), 333–345. https://doi.org/10.1016/j.pedhc.2020.01.008

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Hambleton, A., Pepin, G., Le, A., Maloney, D., National Eating Disorder Research Consortium, Aouad, P., Barakat, S., Boakes, R., Brennan, L., Bryant, E., Byrne, S., Caldwell, B., Calvert, S., Carroll, B., Castle, D., Caterson, I., Chelius, B., Chiem, L., Clarke, S., … Maguire, S. (2022). Psychiatric and medical comorbidities of eating disorders: Findings from a rapid review of the literature. Journal of Eating Disorders, 10(1), 132. https://doi.org/10.1186/s40337-022-00654-2
  • Hunt, G. E., Malhi, G. S., Lai, H. M. X., & Cleary, M. (2020). Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: Systematic review and meta-analysis. Journal of Affective Disorders, 266, 288–304. https://doi.org/10.1016/j.jad.2020.01.141
  • Melton, T. H., Croarkin, P. E., Strawn, J. R., & Mcclintock, S. M. (2016). Comorbid Anxiety and Depressive Symptoms in Children and Adolescents: A Systematic Review and Analysis. Journal of Psychiatric Practice, 22(2), 84–98. https://doi.org/10.1097/PRA.0000000000000132
  • Sharma, E., Sharma, L. P., Balachander, S., Lin, B., Manohar, H., Khanna, P., Lu, C., Garg, K., Thomas, T. L., Au, A. C. L., Selles, R. R., Højgaard, D. R. M. A., Skarphedinsson, G., & Stewart, S. E. (2021). Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry, 12, 703701. https://doi.org/10.3389/fpsyt.2021.703701
  • Saha, S., Lim, C. C. W., Cannon, D. L., Burton, L., Bremner, M., Cosgrove, P., Huo, Y., & McGrath, J. (2021). Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depression and Anxiety, 38(3), 286–306. https://doi.org/10.1002/da.23113

Interventions

  • Bahji A, Pierce M, Wong J, Roberge JN, Ortega I, Patten S. Comparative efficacy and acceptability of psychotherapies for self-harm and suicidal behavior among children and adolescents: A systematic review and network meta-analysis. JAMA Netw Open. 2021;4(4):e216614. doi:10.1001/jamanetworkopen.2021.6614
  • Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Frontiers in Psychology, 10, 543. https://doi.org/10.3389/fpsyg.2019.00543
  • Chang, P. G. R. Y., Delgadillo, J., & Waller, G. (2021). Early response to psychological treatment for eating disorders: A systematic review and meta-analysis. Clinical Psychology Review, 86, 102032. https://doi.org/10.1016/j.cpr.2021.102032
  • Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. H. (2016). How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry, 15(3), 245–258. https://doi.org/10.1002/wps.20346
  • Cipriani, A., Zhou, X., Del Giovane, C., Hetrick, S. E., Qin, B., Whittington, C., Coghill, D., Zhang, Y., Hazell, P., Leucht, S., Cuijpers, P., Pu, J., Cohen, D., Ravindran, A. V., Liu, Y., Michael, K. D., Yang, L., Liu, L., & Xie, P. (2016). Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: A network meta-analysis. The Lancet, 388(10047), 881–890. https://doi.org/10.1016/S0140-6736(16)30385-3
  • Correll CU, Cortese S, Croatto G, et al. Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review. World Psychiatry. 2021;20(2):244-275. doi:10.1002/wps.20881
  • Viswanathan M, Kennedy SM, McKeeman J, et al. Treatment of Depression in Children and Adolescents. Agency for Healthcare Research and Quality (AHRQ); 2020. doi:10.23970/AHRQEPCCER224
  • Zhou X, Hetrick SE, Cuijpers P, et al. Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis. World Psychiatry. 2015;14(2):207-222. doi:10.1002/wps.20217
  • Zhou X, Teng T, Zhang Y, et al. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. The Lancet Psychiatry. 2020;7(7):581-601. doi:10.1016/S2215-0366(20)30137-1

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