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Adults aren't the only ones who get depressed. Children and teenagers can get depression, too. But depressed young people often hide their feelings, and the symptoms aren't always clear. As a parent, you may have a hard time knowing if your child is depressed or just going through a phase.

Children who are depressed may lose interest in doing things they used to enjoy. For example, your child may not want to play with friends or play sports any more. And your child may seem cranky.

Older children may start getting into trouble at school. It's normal for teenagers to have moods, but depression is more than just being moody.

Depression is an illness. It can get worse if it isn't treated. Depressed children may be at risk for suicide if they don't get the help they need. This illness can also stop your child from getting the most out of this important time in life.

Depressed children can be helped with the right treatment. As a parent, caregiver or teacher, don't wait more than a few weeks to see if a child's low mood goes away.

In these pages, we're looking at depression in children and teenagers ages 6 to 18.

• Depression is common among children and teenagers. At any time, 8 in every 100 teenagers may be depressed.¹
• You may not realize your child is depressed because the symptoms aren't always clear.
• Depression can be treated. If you think your child might be depressed, talk to your doctor.
• Talking treatments (psychotherapy) can help symptoms of depression in children, especially if the depression is mild.
• Treatment with drugs called antidepressants may help some young people whose depression is bad (severe). But there's a risk of side effects. The antidepressant doctors usually use for older children is fluoxetine (brand name Prozac).
• Half of depressed children get better within a year. But many get depressed again. They're also likely to have depression as adults.
• Depression is a serious condition. A third of depressed children and teenagers try suicide, although fortunately very few succeed.

It can be hard to convince young people that they might be ill and need help. If you're a teenager reading this and you think you or a friend might be depressed, see Teenagers and depression. It's important to get help.

We all feel down sometimes, but depression is more than feeling unhappy. It's a low mood that doesn't go away. It can affect how a child feels, thinks and behaves.² Depression can make it hard for a child to get along with life and with others.

Even though a child may be feeling very low, this isn't always obvious. Many children and teenagers find it hard to talk about their low mood. They may be grumpy or they might stop doing things they once enjoyed, such as sports and playing with friends.^{2 3}

The depression can slow down children's thinking, too. They may start to blame themselves if even a small thing goes wrong. And a child may seem to have less energy. But they can be restless and anxious at the same time.

Depression in children is similar to depression in adults, but there are differences.^{2 3} Children may deny feeling sad. They are more likely to say they feel down or grumpy. Teenagers may feel hopeless but won't be able to talk about it.

Besides being in a low mood, you might notice that your child:^{2 3 4}

• Doesn't feel like eating or is eating more than usual
• Is gaining or losing weight. Younger children may not be putting on the weight they should
• Is sleeping too much or too little. Your child might start sleeping a lot or have trouble sleeping at night
• Is behaving differently. Some children withdraw from family or friends, stop caring about how they look or lose interest in things they used to enjoy. Some become aggressive, and they may have problems with school
• Doesn't have any energy. Some children with depression often say they feel tired
• Gets headaches, stomach aches or pains in the arms or legs
• Blames himself or herself for things that go wrong. Children may say that they're no good. Feeling guilty is common
• Has a hard time concentrating, making decisions or thinking clearly. Your child's grades at school may suddenly drop
• Is irritable
• Harms himself or herself. For example, some children try to cut themselves. And some think about suicide if they're very depressed
• Drinks alcohol or uses drugs. Some depressed teenagers may use alcohol and drugs to numb their feelings. But it may be that the drugs and alcohol are making them depressed.

Some of these feelings happen in all children and teenagers from time to time. But with depression, these feelings build up and don't go away.

It's easy to miss the signs that a child or teenager is depressed. Young people often find it hard to talk about their feelings. Only a third of teenagers who need help for depression will ask for it.² And younger children can't always explain the way they feel. That's why depression comes out in other ways, such as in having temper tantrums or headaches.

Other signs of depression, particularly in children, can include fear of school or fear of being away from parents.⁴ Some teenagers who are depressed also can't stop thinking about small things and are anxious.

Watching out for the early warning signs that a child might be depressed is important. Children and teenagers who have a low mood, but perhaps not enough for a diagnosis of depression, are at a high risk of getting worse.^{2 5} Take note if your child loses interest in their friends and usual activities and stops talking to other family members. To learn more, see Depression: the warning signs.

No one knows for sure what causes depression. We know that certain things that happen in life can put a child at risk for getting this illness. For example, they might have lost a parent or are being bullied at school. But depression is also linked to changes in how the brain works. This makes sense because how you think, feel, sleep and behave, and how hungry you feel are all controlled by your brain.

Your brain sends signals from cell to cell using chemicals called neurotransmitters. In adults who are depressed, the neurotransmitters called norepinephrine and serotonin don't work properly.⁶ But there's not enough research to know for sure if this happens in depressed children.⁷

The hormones that control many things in your child's body might cause depression if they're out of balance. Having too much of a hormone linked to stress, called cortisol, in the brain has been linked to depression.⁸ The change in hormone levels that happens at puberty may also trigger depression, especially in girls.

The word depression describes a range of emotions. We often say we're depressed when we're down in the dumps or feel miserable. Depression is also used to describe having no hope at all and avoiding others. These things stop you from doing what you used to enjoy or getting on with life.

Doctors sometimes use other words to describe different types of depression. In these pages, we are looking at how major depression can affect your child and be treated. But you may also find our information useful if your child has dysthymia. That's a milder but longer-lasting type of depression. For more, see Types of depression.

We don't really know what causes some children and teenagers to get depression. But there are things that increase a young person's chance of getting depressed. Doctors call these risk factors. Having these risk factors doesn't mean your child will get depression for sure. It just means that they're more likely to get it.

Some examples of things that put young people at risk for depression are lots of fights with their parents, not having any close friends, having depression run in the family and being a girl. For more, see Risk factors for depression in children and teenagers.

Lots of things can put your child at risk for depression. Depression is probably caused by a combination of many things and not just one thing.²

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.