Up to 25% of youth will have an episode of depression by the time they have gone through adolescence. Females are two to three times more likely to experience depression than boys. Depression is comparatively less common in pre-pubertal children.
Depression is diagnosed in the DSM-5 by having at least five of the nine possible symptoms listed below. In addition, at least one of the symptoms has to be #1 (depressed mood) or #2 (loss of interests).
- Sad, depressed mood. Irritable mood may substitute for sad mood, but many believe that sad mood should still be evident.
- Loss of interest in usual activities
- Change in appetite or weight (increase or decrease)
- Sleep difficulty (insomnia or hypersomnia)
- Psychomotor agitation or retardation
- Low energy or fatigue
- Poor concentration
- Excessive/ Inappropriate feelings of guilt, worthlessness, or hopelessness
- Recurrent thoughts of death
Symptoms need to be present for a minimum of 2 weeks to make a formal diagnosis.
How is it Diagnosed/Measured?
Interview with a doctor or counselor. There are no lab or computer tests to diagnose depression.
A standardized checklist can be helpful to thoroughly cover all of the symptoms and measure the severity of depression. The Centers for Epidemiologic Studies Depression scale (CESD) is a free, public domain self-report checklist. Child-report and caregiver-report versions can be downloaded below. A score of 16 or higher correlates with diagnosis of depression (Note: Items #4, 8, 12, and 16 must be reverse-scored).
When to Refer/Seek Help?
People can experience many of the symptoms of depression from external causes such medical problems or drastic life changes. If it seems that the depression is due to an external cause, and those external events have disappeared or are changing for the better, it can be reasonable to wait and watch.
Most of the time however, there is no external cause that is solely to blame, and the depression is due to a combination of genetic vulnerability and stress. If symptoms are not improving after several weeks, it is time to seek help.
Episodes of depression can last for months to years. Even if depression resolves on its own, research has shown that depression recurs in more than half of people in later years.
Either psychotherapy or medication alone can be effective for depression, and the combination of both is often more effective. It is not possible yet to predict beforehand who will benefit from particular types of treatments.
Several selective serotonin reuptake inhibitor (SSRI) medications have been approved for youth: fluoxetine (Prozac) (approved for >7 years), and escitalopram (Lexapro) (approved for > 11 years). The other SSRI medications are commonly used in practice as an "off-label" prescribing practice.
These medications carry a black box warning required by the Food and Drug Administration in 2004 which states that increased suicidal ideation and behaviors may occur with SSRI's in individuals below 25 years of age. There is considerable controversy however about this black box warning. Many believe that this has caused a significant decline in youth being treated for depression and a subsequent rise in suicides (Cuffe, 2007).
In the U.S., suicide is the third most common cause of death in the 15 to 24 years age group; in 2010, there were approximately 4,600 deaths by suicide in this age group (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System).
While many people who commit suicide have depression, estimates vary widely on what percentage of people who commit suicide have any mental disorder.
Warning signs may include lack of future planning, putting affairs in order, comments like, “I won’t be a problem for you much longer,” and suddenly becoming cheerful after a period of depression.
Additional general information on depression in youth is available from the National Alliance on Mental Illness.
A more consumer-driven, community-style resource is TheMighty.com.
- Updated March 6, 2019