Depression

Depression

What is depression?

People of all ages, including youth, sometimes feel down, depressed, or irritable. These feelings can happen for anyone, especially when something stressful happens, like moving to a new place, going to a new school, or experiencing a significant change in a friendship or relationship. For some people, however, these feelings are more severe, last longer than expected, and start to affect parts of daily life such as eating, sleeping, relationships, or school. If this is the case, an individual may be experiencing a depressive episode. Recent data suggest that approximately 11 percent of youth between the ages of 12 and 17 experience an episode of depression during the course of a year[1]. Because depression is related to other health difficulties, including an increased risk of self-harming or suicidal behaviors, it is important to watch carefully for warning signs.

To learn more about depression, use the links below.

What does depression look like?
What's the difference between feeling depressed and depression? When to Get Help
How is depression diagnosed?
Are there different types of depression and other mood disorders?
How is depression treated?
Where to Get Help

What does depression look like?

Depression can look different in youth than in adults, and everyone’s experience of depression is unique. However, there are some common characteristics of a depressive episode. Depression in children and adolescents often involves feeling sad or irritable, being withdrawn, feeling bored, and having less interest in things that are usually enjoyable. Additional signs of depression in youth include:

  • increased tearfulness/crying;
  • hopelessness;
  • sensitivity to rejection or failure;
  • thoughts of suicide;
  • thoughts of running away;
  • low energy;
  • social isolation;
  • relationship problems;
  • changes in eating or sleeping;
  • difficulty staying focused or making decisions;
  • problems with school; and
  • physical complaints (e.g., headaches and stomachaches).

Also, it is common for individuals who experience depression to experience anxiety as well.

What’s the difference between feeling depressed and depression? When to Get Help

As mentioned above, everyone may feel depressed or sad sometimes. When a young person feels depressed after the loss of a pet or a disappointing basketball game, for example, this does not automatically mean she or he is experiencing an episode of depression. However, when these feelings impact one’s ability to manage everyday life, and are more severe or last longer than expected, then depression might be present. For example, some youth with depression might:

  • have more conflicts with friends or family;
  • have difficulty getting out of bed or leaving her or his room;
  • show a decrease in school performance; or
  • refuse to go to school.

If you suspect that a child, adolescent, or young adult is experiencing depression, it could be time to consult with a professional.

How is depression diagnosed?

Depression can be diagnosed by trained mental health professionals, including psychologists, clinical social workers, psychiatric nurse practitioners, and psychiatrists. Many youth and families first consult with a primary care physician, who may able to help make referrals to mental health services. Mental health professionals will complete a comprehensive mental health assessment. For youth under the age of 18, this can involves both the youth and her or his caregivers. Youth might meet with the mental health professional both with and without their caregivers, depending on the primary concerns and the style of the clinician. For young adults age 18 to 26, caregivers may also be involved, depending, again, on the presenting problems and the style of the clinician. A diagnosis is determined based on whether the criteria are met for one of the depressive disorders briefly listed below. If a diagnosis of depression is made, the clinician will provide further information and education about the disorder and recommendations for treatment.

Are there different types of depression and other mood disorders?

Yes. The different types of depression and other mood disorders are distinguished by characteristics such as what symptoms are present, when and how the symptoms developed, and how long the condition has continued. Below are the various types of depressive disorders:

  1. Disruptive mood dysregulation disorder can be diagnosed in children 12 years and under, and it is characterized by a frequently irritable mood with periods of extreme emotional and behavioral outbursts.
  2. Major depressive disorder is characterized by at least one depressive episode that lasts two weeks or longer and consists of multiple symptoms of depression and impaired functioning. Though this disorder can be diagnosed following a single depressive episode, most individuals experience recurring depressive episodes, with periods of little to no depression occurring between episodes. Seasonal affective disorder is a type of major depressive disorder.
  3. Persistent depressive disorder (dysthymia) is a more chronic type of depression. In youth, this disorder can be diagnosed when the symptoms have lasted one year or more.
  4. Premenstrual dysphoric disorder is another episodic form of depression linked to an individual’s menstrual cycle in which the symptoms appear around the week before menstruation and end shortly after menstruation.
  5. Substance/medication-induced depressive disorder is considered when the symptoms of depression occur around the time of substance/medication use, and the substance/medication is known to sometimes cause symptoms of depression. For example, a depressive episode may occur during the use or abuse of alcohol or after the abuse of alcohol when experiencing withdrawal symptoms.
  6. Depressive disorder due to another medical condition is similarly considered when the symptoms of depression are known to be linked to the physiological effects (effects on the body) of the medical condition.
  7. Other specified depressive disorder can be diagnosed when youth experience symptoms of depression and experience significant distress, but they do not meet full diagnostic criteria for any of the depressive disorders listed above. The classification of “other specified depressive disorder” allows a clinician to indicate what criteria are not met. For example, a clinician might specify that the depressive episodes a youth experiences last less than two weeks.
  8. Unspecified depressive disorder can be diagnosed when youth experience symptoms of depression and experience significant distress, but they do not meet full diagnostic criteria for the depressive disorders listed above.

How is depression treated?

Depression is generally treated with psychotherapy, medication, or a combination of both.

Psychotherapy for Child and Adolescent Depression

While there are many different forms of therapy, research has shown some treatments to be particularly beneficial for child and adolescent depression. These evidence-based psychotherapies for youth with depression include cognitive behavioral therapy (CBT), interpersonal therapy for adolescents (IPT-A), and family therapy. While these treatments all have standard components, it is important for any treatment plan to be tailored to each individual youth, caregiver, and/or family. Consulting with a mental health professional about what treatment is the best fit can greatly increase its benefit.

Medication for Child and Adolescent Depression

For some youth diagnosed with a depressive disorder, medication is recommended. People may be familiar with a class of antidepressant medications commonly used to treat depression called selective serotonin reuptake inhibitors (SSRIs). This class of medications includes fluoxetine (Prozac), which is currently the only FDA-approved antidepressant medication for treatment of depression in youth. If a youth does not benefit from fluoxetine or is unable to take fluoxetine for other reasons, providers may also prescribe trials of other SSRIs off-label (e.g., the medication is prescribed to treat a condition, or in a manner, other than that that was officially approved by the FDA), such as sertraline (Zoloft), Please note that SSRIs have a “black box” label warning for youth indicating that they might be associated with an increased risk of suicidal thinking and behavior.[2] It is critically important to discuss all medications in detail with your healthcare providers, and to inform them of any unusual side effects or feelings that you or your child experience.

Where to Get Help

Help can come from many sources, and where to seek help is a personal and family decision. If you think you have, or that your child has, a depressive disorder, however, it is important to seek help from a trained professional, such as a psychiatrist, psychologist, psychiatric nurse practitioner, or social worker, who can evaluate your or your child’s symptoms and make recommendations for effective treatment. You can also raise your concerns with your child’s pediatrician or your primary care doctor. If it is suspected that you or your child has a depressive disorder, the pediatrician or primary care doctor will likely refer you or your family to a mental health professional. As some of the symptoms of depression can be physical, consulting a physician is also recommended to rule out any existing physical illness.

For treatment in the New York metropolitan area, visit our Clinics, Doctors, and Services page or ColumbiaDoctors Children’s Health for a list of Columbia University Medical Center providers who treat child and adolescent depression and other mood disorders. You can also call (212) 305-6001 to get more information and—if appropriate—a referral. Families looking for health care in community clinics or a hospital setting in the Washington Heights area may also call (212) 305-0924. In addition to clinical care, the Columbia University Pediatric Anxiety and Mood Research Clinic runs a limited number of treatment research studies focusing on treatment for child and adolescent depression and other mood disorders.

Other ways to get help include speaking to someone at your child’s school, contacting your insurance provider, or looking for support services through your city or town. In New York City, NYC Well (call 1-888-NYC-WELL or text “WELL” to 65173) is a confidential, 24/7 toll-free help line for New York City residents with mental health concerns. The NYC Department of Health also publishes a list of child and mental health services.


[1] Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/.

J. P. Reyes, PhD, is a clinical psychologist at the Special Needs Clinic in the Department of Pediatric Psychiatry at NewYork-Presbyterian Hospital/Columbia University Medical Center. There he works with youth, adults, and families affected by chronic medical illness. Dr. Reyes specializes in the evaluation and treatment of depressive, anxiety, trauma-related, mood, and behavioral disorders using evidence-based interventions including cognitive behavior therapy (CBT) and parent management training (PMT). He is also invested in the training of new clinicians and provides supervision to psychology and psychiatry trainees.