An Overview of Depressive Disorders in Children

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While there are many types of depressive disorders, the most common types in children are major depressive disorder (MDD), dysthymic disorder (DD), and disruptive mood dysregulation disorder (DMDD). Depressive episodes are also a key feature of bipolar disorder in children.

The good news is that depressive disorders in children are treatable. If you recognize the signs and symptoms in your child, a mental health professional can work with you and your family to find the right treatment plan to reduce symptoms and increase your child's quality of life.

Types of Depressive Disorders

Here is a look at the different type of depressive disorders in children, along with the symptoms, causes, risk factors, diagnosis, treatment, and coping tips.

Major Depressive Disorder

Major depressive disorder is a severe condition in which a child experiences episodes of depression. The episodes typically last seven to nine months.

According to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms of childhood depression can include:

Additionally, children with MDD may exhibit symptoms of anxiety, like shyness, fear, and unexplained physical complaints.

Approximately 2% to 3% of children under age 10 meet the criteria for MDD, but between the ages of 10 and 14, the rate increases to 5% to 8% for children overall. Approximately twice as many girls will experience depression as boys by age 15. Prior to puberty, boys have a higher rate of depression than girls.

Recovery rates for MDD are high for children who receive treatment. However, so are recurrent episodes of depression. The National Institute of Mental Health (NIMH) suggests early identification and treatment of depression in children, given the short- and long-term consequences, such as poor self-esteem, substance abuse, risk-taking, poor academic performance, poor social development, and risk of suicide.

Dysthymic Disorder

Also called persistent depressive disorder, dysthymic disorder is a persistent but milder mood disorder than MDD, lasting at least two years. Children with DD are more functional than children with MDD. Despite their symptoms, children with DD can usually attend school and participate in activities that some children with MDD may not be able to. Children with DD may have suffered from DD for so long that they believe their depressed state is "normal." Parents or others close to the child may just think that she has a shy or introverted personality rather than a depressive disorder.

Symptoms of DD in children are similar to symptoms of MDD, but less severe. The rate of DD in children is 3%. According to Dr. Daniel Klein and colleagues, who published a study in the Journal of Psychiatric Research in 2008, 75% of those children go on to experience MDD. The combination of MDD and DD is considered "double depression."

Recovery rates for dysthymic disorder are high in children, especially with appropriate treatment. Again, so are relapses. Dr. Klein and colleagues found that relapse rates for DD were approximately 70% over 10 years in children. Additionally, it was reported that the longer a child lives with DD, the more likely they are to experience MDD or DD.

Disruptive Mood Dysregulation Disorder

Added to the DSM-5 for children up to 18 years of age, disruptive mood dysregulation disorder (DMDD) is a condition characterized by extreme anger and irritability and frequent, intense temper outbursts. This pattern of behavior is beyond a child who is "moody" or who throws "temper tantrums." Instead, children display a pattern of abnormal, episodic, and frequently violent and uncontrollable social behavior without provocation.

Symptoms of DMDD include irritable or angry mood most of the day (nearly every day), severe temper outbursts (three or more times per week), and trouble functioning due to irritability at home, school, or with peers. To be diagnosed, a child must exhibit these symptoms steadily for 12 or more months. The onset for DMDD is typically age 10, and children under 6 or over 18 can't be diagnosed.

Since DMDD is a relatively new diagnosis, treatment is based on what has been proven to work to alleviate symptoms of MDD as well as attention deficit hyperactivity disorder (ADHD), anxiety disorders, and oppositional defiant disorder.

Bipolar Disorder

Depression can occur as part of bipolar disorder. This is a condition in which the child experiences manic as well as depressive episodes.

There is some controversy over the diagnosis of bipolar disorder in children. This is because it is often misdiagnosed.

The onset for BD is typically late adolescence or early adulthood but can occur in young children. Symptoms of BD in young children are different than in adults: Children before age 9 may show irritability and psychomotor agitation, increased or repetitive movements, paranoia, and psychotic symptoms.

After the age of 9, BD symptoms are similar to adults with BD: Elation or overly excited state; risk-taking; ability to function on little or no sleep; racing thoughts; fast or loud talking; disorganization; and exaggerated sense of abilities or accomplishments.

Bipolar disorder occurs in 1% to 3% of adolescents and rates have increased forty-fold in the last decade, according to the NIMH.

Treatment is always needed for children with BD given its serious consequences, like poor academic performance, disturbed personal relationships, substance abuse, and suicide. Medication can be helpful in stabilizing a child's mood, but BD is often a lifetime disorder.

Symptoms

There are various types of depressive disorders, and each can have a different impact on a child's life. In general, however, depressive disorders can cause sadness and irritability and make it difficult for children to keep up with daily tasks and demands of life and result in poor school performance, withdrawal from friends and family, and risky or delinquent acts.

Causes

No one knows the exact causes of depressive disorders in children, but a variety of factors seem to contribute, including genetics and chemical imbalances in the brain. Past trauma, sexual abuse, poor childhood relationships with parents, and a history of a personality disorder can also trigger depression, especially if there's a family history.

Diagnosis

If you think your child may have a depressive disorder (or any other mental health issue), schedule an appointment with your child's pediatrician. The physician may run several blood tests to rule out any health conditions (infectious mononucleosis, thyroid disorders, drug abuse, etc.) that can cause or mimic symptoms of depression and refer you to a mental health treatment provider for a complete evaluation. There isn’t a lab test that diagnosis depressive disorders.

During your visit, it's important to offer as much information as you can about your child's mental health background and current symptoms, including mood, sleep patterns, energy levels, and behavior. This will allow the doctor to make an informed diagnosis.

Treatment

Treatment for a depressive disorder may require adjustments over time and involve a combination of psychotherapy, medication, and lifestyle changes.

Psychotherapy (Talk Therapy)

A therapist may educate your child about their particular depressive disorder and may offer coping strategies to help manage the symptoms. Therapy often includes family members in order to address relationship issues, behavior management problems, and strategies to help the entire family cope.

Treatment that involves the child, family, doctor, and school often works best, so it's important to attend your child's therapy appointments, ask questions, and communicate with the school and other treatment providers.

Your therapist or psychiatrist may even ask you to log your child's progress to determine what's working and what's not.

If your child is a safety risk (thoughts of suicide, a suicide attempt, self-harm, hallucinations, self-injury), a stay in a psychiatric hospital may be required.

Medication

A psychiatrist may prescribe a stimulant, antidepressant, or atypical antipsychotic medication to stabilize your child's mood. Finding the right medication and the right dosage may take some time as there isn’t a single medication that works best for everyone.

It’s important to monitor your child’s medication and be on the lookout for side effects. Make sure to call your doctor immediately if your child is exhibiting suicidal ideation or suicidal behavior while taking an antidepressant. All antidepressants carry an FDA black-box warning of an increased risk in suicidal thinking for those under age 25, particularly in the first few weeks of starting treatment.

Lifestyle Changes

Helping your child to make nutrition, regular exercise, proper sleep, and stress management part of their everyday lives can also help alleviate some of the symptoms of depressive disorders. It's also important for you to set a good example by making these healthy lifestyle habits part of your daily living, too.

Coping

Depressive disorders impact the entire family, so it’s important for the parents, caregivers, and siblings to learn as much as they can about depressive disorders. This will ensure that everyone knows what to expect and what warning signs to watch for.

Work closely with your child's mental health professional and be sure to ask questions and stay up-to-date on the latest treatment options.

At some point, your child may resist medication or therapy, and it's important to validate their feelings and talk about why following the doctors' recommendations and sticking to their individualized treatment plan will increase their chances of feeling better.

Taking time to take care of yourself will also help you better cope. Raising a child with a depressive disorder is stressful and challenging and you'll need emotional support and practical advice along the way. Consider joining a support group for parents with children with mental illness.

A Word From Verywell

If you notice symptoms of a depressive disorder in your child, be willing to talk about it with your child and do your best to remain supportive and non-judgemental. While it can be terrifying to hear that your child has MDD, DD, DMDD, or BD, it is not a "life sentence." Early interventions can help kids get back on track before symptoms take a serious toll on their life and ability to function.

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