The signs, symptoms, and diagnosis criteria Depression. We offer information, suggestions and help for individual and families dealing with depression.

Understand the diagnosis, what to do next and access resources

Depression is the constant feeling of sadness intensified by feelings of hopelessness and helplessness over the course of many weeks. There are many different types of depression including: Major depression, Chronic depression (dysthymia), Bipolar depression, Seasonal depression (SAD), Psychotic depression, Postpartum depression, Substance-induced mood disorder (SIMD). Here we cover depression as a whole.

Depression diagnostic criteria

According to the 5th edition of the Diagnostic and Statistical Manual depression occurs when a person has at least five of the following symptoms at the same time:

  • A depressed mood during most of the day, particularly in the morning.
  • Fatigue or loss of energy almost every day.
  • Impaired concentration, indecisiveness.
  • Insomnia (an inability to sleep) or hypersomnia (excessive sleeping) almost every day.
  • Markedly diminished interest or pleasure in almost all activities nearly every day.
  • Recurring thoughts of death or suicide (not just fearing death).
  • A sense of restlessness or being slowed down.
  • Significant weight loss or weight gain.

Depression symptoms in children and teens are similar to symptoms in adult, but there are some differences. In order to be diagnosed with depression, these signs should be present most of the day either daily or nearly daily for at least two weeks. They must also cause clinically significant impairment of normal activities or distress to the child.

In children, symptoms include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.

In teens, symptoms include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

It is important to rule out other existing conditions before a depression diagnosis is made including: death of a loved one, substance abuse, moving to a new town or area, medical condition, etc.

Depression manifests itself differently in every child. These feelings may be long or short and vary on intensity. Evaluating your child will be the job of the parent and mental health professional. Parents may observe some of the following behaviors if their child is depressed:difficulty concentrating, difficulty making decision, decreased energy, overeating or appetite loss, physical pains that do not improve even after treatment, irritability, thoughts of suicide or suicide attempts.


Diagnosis confirmed. Now what?

After your child receives a depression diagnosis, parents will need to evaluate what kind of help their child needs, including monitoring and a safety plan for children who are at risk for self harm, suicidal behaviors, or injury.


​Become informed and know your options

Each child is different. Depression also manifests itself differently in every child. It is important to be educated about depression and treatment options in order to find what will work best for your child. Depression is most often treated with psychotherapy, medication or a combination of both. The use of mindfulness in treating depression is on the rise in recent years. Regardless of the treatment approach, parents and children should be patient as it takes time for improvement to happen. Be sure you check with your child’s physician to verify there is no underlying cause for the symptoms of depression.


It is important to find a therapist that your child feels comfortable with. Being able to build a strong relationship will help reduce isolation often associated with depression and can be an important piece toward recovery. A therapist will use various techniques to address the symptoms of depression and may even recommend group therapy. Therapy approaches used for depression may include: Cognitive Therapy (how we think and interpret events in our lives), Behavioral Therapy (why we do what we do) and Interpersonal Therapy (communication styles and how we relate to others).


Medication can help alleviate some of the symptoms of depression, but it is not a long-term solution. Anti-depressant medication also come with various side effects and withdrawal from these medications can be extremely difficult. The National Institute of Mental Health reports that in some cases, children, teenagers and young adults under 25 years of age may actually experience an increase in suicidal thoughts or behavior when taking anti-depressants. Becoming informed about medications, their side effects and their limitations will help you determine if medication is the right option for you or your child.

Consult a physician about any supplements or natural remedies your child may be taking, especially if you are using them to treat depression. This includes the use of St. John’s wort as it has not been approved by the FDA as safe and combining it with medication can be very dangerous.


Mindfulness has roots in Buddhism and is a meditation technique that helps shift thoughts away from your usual preoccupations toward appreciation and acceptance of what is occurring in the moment. Professor Jon Kabat-Zinn is perhaps the most famous pioneers of the current mindfulness movement in the areas of stress reduction and improving the overall health.

Individuals with depression also benefit from physical exercise, social support networks and good nutrition.

Children with depression can benefit from learning behavior skills that can be reinforced in the home. Smarter Parenting recommends Effective Communication and The ABC’s of Behavior. These two lessons are a good place for children and parents to begin to treat depression symptoms in children.

Customizing Effective Communication for Depression

Learning how to communicate is key in allowing a child to discuss their feelings and their symptoms. Effective Communication kids struggling with depression the tools they need.

Tips for parents using this skill for Depression

  • Communicate about what symptoms manifest for your child.
  • Work out a system to communicate when they are feeling sad and what the intensity it is.
  • Communicate often about treatment and if it is working. Be patient but expect progress, even small progress after a few weeks.
  • Set up a “safe time” for you and your child to communicate. Around 1-4 consecutive minutes. Allow your child to talk about whatever they would like during this time. Do not provide solutions or interject your opinions. Just listen. When it is over, do not reply. You can restate what is said but you cannot interject your own opinions or thoughts. This allows them to share whatever they want. The only instance you would interject your authority is if they talk about harm to self or others. Do this as often as needed by your child.

Customizing ABC’s of Behavior for Depression

Understanding how thoughts precede our behaviors is an important concept for children to understand, especially children with depression. Watch the following video and work with your child to understand how to address their inner thoughts. This approach goes hand-in-hand with mindfulness.

Tips for parents using this concept for Depression

  • Focus on the thought process (Antecendents) first related to the symptoms of depression and talk about them with your child.
  • Relate Antecedents to their “thoughts” and what they are thinking while experiencing depression. Write down those thoughts on a piece of paper and explore what behaviors happen after those thoughts occur.
  • Discuss how those thoughts influence mood. Work on addressing those thoughts to find a way for your child to deal with them in a new way.
  • Continue to work with them on understanding how thoughts are Antecedents and how the behaviors that follow can be chosen and changed at will.

Both of these lessons contain additional games, activities and printable materials to help teach these concepts more effectively with your child. Visit their individual pages on the Smarter Parenting website.

Smarter Parenting blog posts

5 signs of depression in teens

Childhood depression. What does it look like?

The following resources may be helpful

Print out these suggestions about Depression for parents from the American Psychiatric Association.

The National Institute of Mental Health has additional information about depression that may be helpful.

Read this report on Major Depression with Severe Impairment Among Adolescents.

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