Everything you need to know about Depression in Children

In 2021, among children aged 6 to 16 in England, one in six had a probable mental health condition; this is an increase from one in nine children in 2017. In 2021, 24% more patients were in contact with the children and young people’s mental health service (CYPMHS) compared with 2020, and 44% more than in 2019. This included patients who were waiting to be seen.

What is depression?

Depression is a mood disorder that causes a persistent feeling of sadness and low mood. It can also cause people to feel irritable or hopeless. It can also be called major depressive disorder or clinical depression.

Depression can affect how you think, feel and behave and can lead to a variety of emotional, behavioural and physical problems. It may affect your ability to sleep well, your appetite or your relationships with other people. Depression can also cause you to lose interest in hobbies or activities that you used to enjoy. In severe cases, depression can lead to thoughts of suicide or self-harm.

Most people go through periods of feeling low in mood, but when you are depressed, you feel persistently low in mood for weeks or months, rather than just a few days. Most people feel stressed, anxious or low in mood during difficult periods of their lives. Feelings of low mood may improve after a short period of time, rather than being a sign of depression.

Depression doesn’t only affect adults. Children and young people can also become depressed. Depression can affect their relationship with family and friends. It may affect their day-to-day life and prevent them from enjoying school, sports, hobbies or other normal childhood activities. Depression and anxiety are among the most common mental health disorders seen in children.

The symptoms of depression in both adults and children can range from being mild to severe. Mild depression may include feeling persistently low in mood, while severe depression can make you feel suicidal.

Depression is not a sign of weakness and it is important to seek help if you think you may be depressed. Depression will not usually get better on its own and without the right help and support, it may continue to get worse.

Most people with depression feel better with medication, psychotherapy or receiving both treatments simultaneously.

Causes of depression in children

Similar to adults, children have times when they feel low in mood, or sad. Emotional fluctuations are perfectly normal; however, if those feelings and behaviours last longer than two weeks, they may be a sign of depression. Childhood depression is a serious mental health issue, but it is treatable. Similarly, as in adults, children can become depressed due to a number of reasons and it can be complex to determine the exact cause.

Depression can be caused by a combination of things or a singular issue.

Things that can increase the risk of depression in children can include:

• A family history of depression.
• Bullying.
• Difficulties at school.
• Difficulties at home.
• Abuse – This can include physical, emotional or sexual.
• A bereavement.
• Physical health difficulties or a disability.
• Drug and alcohol use in children.

Social media use has also been linked to having a negative impact on children’s mental health in some cases. Internet use can expose children to dangers, such as cyberbullying, online grooming and sexual abuse. Children can easily be exposed to unsuitable or harmful materials online which can cause emotional harm. Think U Know provide some helpful online safety advice and resources.

What are the symptoms of depression in children?

Symptoms of depression in children can often include:

• A persistent sadness or low mood.
• Being grumpy or irritable often.
• Often feeling tired and exhausted.
• Having trouble sleeping or sleeping more than usual.
• Having little interest in things they previously enjoyed.
• Being unable to concentrate.
• Not being as sociable with friends and family.
• Low confidence or self-esteem.
• Talking about feeling guilty or worthless.
• Feeling empty or inability to feel or express emotions.
• Eating less than usual or overeating.
• Noticeable changes in weight.
• Regular physical symptoms, for example, headaches or stomach aches.
• Difficulties coping at school.
• Difficult or angry/aggressive behaviour.
• Bleak and pessimistic views of the future.
• Having thoughts of suicide or self-harming.
• Self-harming, for example, cutting their skin or taking an overdose.

Children who are depressed may also have symptoms of anxiety. Most people feel anxious at times; it’s particularly common to experience some anxiety while experiencing stressful events or life changes. Anxiety is a feeling of unease, such as worry or fear that can be mild or severe. People with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations.

The signs of anxiety in children include:

• Fear of being away from a parent. This is different from normal separation anxiety which is usually seen in babies and young children.
• Physical symptoms can include panic, sweating, dizziness, stomach ache or headaches.
• Refusing to go to school or becoming socially isolated.
• Worrying that a parent or family member may die or become seriously ill.
• Having anxiety about the future.
• Having panic attacks.

Anxiety becomes a problem for children when it starts to get in the way of their everyday life and you should also seek some support for this.

What effect does depression have on children?

A child who is suffering from depression can:

• Be socially isolated.
• Struggle with their relationships with friends and family.
• Struggle with their ability to focus in school.
• Become unable to find enjoyment in the things they used to enjoy.

What to do if you suspect depression in a child

If you think your child is showing the symptoms of depression, it is important not to ignore this as, just like depression in adults, depression in children will not go away on its own.

If you’re worried about a child, whether you are a friend, family member or teacher, encouraging them to talk about how they are feeling can be a very helpful first step. Sometimes children are more likely to open up to a trusted adult who is not their parent. This may be because they don’t want to cause their parent to worry, or they may be particularly worried about something that is happening at home, therefore someone who is not as close to the situation may feel easier to talk to.

If you can encourage them to talk, gently ask what is wrong. If the child does not want to talk, do not apply too much pressure on them as this could make them even more reluctant to open up. You can then repeat the process at another time until they are ready to talk.

Children often express themselves through play. They often act out real-life situations that they have experienced in order for them to process them and make sense of the world. This is a good opportunity for you to show curiosity and engage with them. You could observe them in their play and ask questions or you can join in their play. Let them take the lead on this.

Stressed or upset children sometimes play fighting games with their toys. You can talk to your children about this with curiosity in order to find out if there is anything wrong. It is also important to remember that fighting games can also be completely normal developmentally and this type of rough and tumble play can be healthy for children.

The benefits of rough and tumble and imaginary play can include:

• An outlet to regulate emotions through the release of energy and tension.
• Connection through play due to physical contact, imagination and eye contact.
• An opportunity to play with the experience of having power and control and be in charge of their own world.
• ‘Good characters’ versus ‘bad characters’ can teach children about right and wrong.
• An opportunity to learn about respecting others and boundaries.

During this type of play, you can put boundaries in place to ensure it is safe. If the rough and tumble play becomes aggressive or violent, this could be a cause for concern.

As children can learn so much through play and it can often be a more useful way of connecting with a child than just by simply talking, it is often used as a tool when working with children.

If a child is fighting outside of play or being aggressive, there is usually an underlying reason for this and they may need help and support with this. Anger is a normal and useful emotion, but anger can become a problem if a child’s angry behaviour becomes out of control or aggressive.

If a child opens up to you about how they are feeling, whatever is causing the problem, you should take it seriously, even if it seems trivial to you. If your child does not want to talk to you, let them know that you’re concerned about them and that you are there if they need you. You should encourage them to talk to someone else they trust, such as another family member, a friend or someone at school. It may be helpful for you to talk to other people who know your child and speak to your child’s school so that they can offer some support.

If you are worried that any child is being abused, or if a child discloses something to you that you are worried about, you can speak to the NSPCC who will be able to offer advice and tell you how you can report your concerns.

How is depression in children diagnosed?

An assessment of the child will be needed before a diagnosis of depression is made. This will involve taking details of family history and the symptoms the child is presenting with.

Mild depression may be diagnosed if there is persistent sadness, low mood or irritability plus two other associated symptoms.

Moderate depression may be diagnosed if there is persistent sadness, low mood or irritability plus three or four other associated symptoms.

Severe depression may be diagnosed if there is persistent sadness, low mood or irritability plus four or more other associated symptoms.

What are the treatments for depression in children?

Treatment for depression almost always involves therapy, and it can include medication as well.

One of the most effective therapies for depression is cognitive behavioural therapy (CBT). CBT is a talking therapy that can help an adult or child manage their problems by changing the way they think and behave.

Talking therapies can help all sorts of people in lots of different situations. You may also hear them referred to as counselling, talking treatments or psychological therapies.

Play therapy is a form of therapy used mainly for children. Children may not be able to process their own emotions or articulate problems to parents or other adults. A trained therapist can use playtime to observe and gain insights into a child’s problems. The therapist can then help the child to explore their emotions and deal with unresolved trauma. Through play, children can learn new coping mechanisms and how to redirect inappropriate behaviours.

When therapy alone isn’t enough, children can also take medication for depression. A psychiatrist can prescribe medication. If medication is prescribed, this will usually be given as well as therapy being recommended.

While antidepressants have been shown to be effective in treating severe depression and anxiety in children, they should be used cautiously and monitored closely to make sure there are no serious side effects.

The most serious potential side effect of antidepressant use is their potential to increase the risk of suicidal thoughts and behaviours. This side effect is rare. Most medications used to treat depression in children have a black box warning about the possibility they could increase the risk of suicidal thoughts.

The signs of suicidal thoughts in children can include:

• Expressions of hopelessness about the future.
• Feelings of worthlessness, shame, guilt or self-hatred.
• Anxiety or restlessness.
• Aggressive or hostile behaviour.
• Withdrawal from friends and family and increased social isolation.
• Being missing from home (usually more often seen in older children/teenagers).
• Increased risk-taking behaviours.
• Giving away their possessions.
• Preoccupation with death in conversation, writing or drawing.
• Having many of the symptoms of depression.

For further reading about how to support someone who is feeling suicidal, please see our knowledge base.

Support available

If you are worried about your child’s mental health, you should make an appointment to see your GP. Your GP can refer your child to a local children and young people’s mental health service (CYPMHS) who are able to provide specialist help.

CYPMHS is used as a term for all services that work with children and young people who have difficulties with their mental health or wellbeing. You may also be able to refer your child directly to this service without seeing your GP. Specialist CYPMHS are NHS mental health services that focus on the needs of children and young people.

 They are multi-agency teams that often consist of:

• Psychiatrists.
• Psychologists.
• Social workers.
• Nurses.
• Occupational therapists.
• Support workers.
• Specialist substance misuse workers.
• Education mental health practitioners – Who work in mental health support teams in schools and colleges.
• Children’s wellbeing practitioners.
• Primary mental health workers.

Accessing support from a specialist CYPMHS is different depending on where you live, and waiting times can also vary. Most CYPMHS have their own website, which will have information about how to access the service, including phone numbers, so you can get in touch directly to ask for advice.

You may also find it helpful to speak to:

• Someone at your child’s school.
• Your health visitor.
• Someone at your local children’s centre.

If you or your child is being supported by social services or the youth offending team, your key worker will also be able to refer your child to CYPMHS.

If you need help for a mental health crisis or emergency, you should get immediate expert advice and assessment. Here you can find access to an urgent NHS mental health crisis helpline.

If you are worried about any aspect of your child’s mental health, you can call the charity Young Minds free parents helpline for advice on 0808 802 5544. Their lines are open Monday to Friday from 9.30am until 4pm.