13 min read

Feeling sad, irritable, or down from time to time is a normal part of growing up. However, if these feelings become overwhelming, last for weeks, and start interfering with school, friendships, or family life, it may be a sign of depression.

Depression is a recognized medical condition that affects about 2% to 3% of children under 12, and upwards of 5% to 7% of teenagers. It is not a sign of weakness, a phase, or a reflection of your parenting. With the right support and evidence-based treatment, children and young people can and do recover.

Spotting the Signs: How Depression Looks in Young People

Depression can look quite different in a child or teenager compared to an adult. Instead of just appearing "sad," a young person may show changes across their behavior, mood, and physical health:

Emotional & Mood Changes: Persistent sadness, tearfulness, or a noticeable lack of enjoyment in activities they used to love. In children and teens, depression often presents as increased irritability, anger, or extreme mood swings rather than low mood.
Behavioral Changes: Socially withdrawing from friends, skipping school, a drop in academic performance, or changes in behavior (such as acting out or becoming unusually clingy).
Physical & Energy Changes: Feeling constantly exhausted, struggling to sleep (or sleeping far too much), changes in appetite, or unexplained physical complaints like frequent stomach aches or headaches.
Thinking Patterns: Expressing feelings of worthlessness, excessive guilt, hopelessness about the future, or harsh self-criticism.

The Pathway to a Diagnosis

According to the National Institute for Health and Care Excellence (NICE) guidelines, diagnosing depression in a young person requires a careful, comprehensive evaluation by a healthcare professional (such as a GP, school counselor, or a specialist from Child and Adolescent Mental Health Services — CAMHS).

A formal assessment is always tailored to the young person's age and developmental stage and involves several core steps:

Individual & Family Interviews: The clinician will usually talk to the young person alone, as well as with you as parents or carers. This helps them get a complete picture of what is happening at home, at school, and in social settings.
Holistic Evaluation: The professional will look at the young person's history, current stressors (like exam pressure or bullying), and family history of mental health. They will also screen for co-existing conditions, such as anxiety, ADHD, or neurodivergence, which frequently overlap with depression.
Categorizing Severity: Depression is classified as mild, moderate, or severe depending on how many symptoms are present and how heavily they impact daily life. The treatment pathway is directly chosen based on this severity.

Evidence-Based Treatment Plans

NICE guidelines emphasize a "stepped care" approach, meaning treatment starts with the least intrusive, most effective therapies first, before moving to more intensive options if needed.

1. Managing Mild Depression

For mild depression, guidelines strongly advise against using medication as a first step. Instead, the focus is on psychological support and environmental adjustments:

Watchful Waiting & Digital Support: If the symptoms are very recent or mild, a clinician might suggest digital Cognitive Behavioral Therapy (CBT) or a brief period of monitoring (around 2 to 4 weeks) alongside basic sleep hygiene and lifestyle support to see if symptoms improve naturally.
Brief Psychological Interventions: If symptoms persist, a brief psychological therapy (such as a short course of guided self-help, group CBT, or family-focused therapy) is recommended.

2. Managing Moderate to Severe Depression

If a young person is diagnosed with moderate to severe depression, a more structured and robust treatment plan is put into action. NICE guidelines state that specific talking therapies must be offered first. These should last for at least 3 months and typically include:

Cognitive Behavioral Therapy (CBT): Helps the young person identify unhelpful thought patterns and behaviors, replacing them with healthier coping mechanisms.
Interpersonal Psychotherapy for Adolescents (IPT-A): Focuses on relationships, communication, and navigating life transitions or conflicts with peers and family.
Family Therapy: Explores how family dynamics can support the young person's recovery and helps communication within the home.

Pharmacological Treatment (Medication)

If a child or young person (aged 5 to 18) has moderate to severe depression that has not responded to psychological therapy after 4 to 6 sessions, or if their symptoms are safely unmanageable without medical support, medication may be considered.

The First-Line Choice: Fluoxetine (a type of Selective Serotonin Reuptake Inhibitor, or SSRI) is the only antidepressant with clear clinical evidence showing that its benefits outweigh its risks for children and young people.
Second-Line Alternatives: If Fluoxetine causes unmanageable side effects or does not help after an adequate trial, a specialist may consider changing to alternative medications, such as Sertraline or Citalopram, though these are used cautiously and off-label under strict specialist oversight.

The following medication options may be considered under specialist supervision:

What to Expect and Monitor During Medication

When a young person starts an antidepressant, they require careful monitoring, particularly during the first few weeks of treatment:

Frequent Early Reviews: Your specialist clinic will arrange to see the young person very frequently (typically weekly or bi-weekly) during the first month of starting or changing a dose.
Monitoring Side Effects: While generally well-tolerated, side effects can include temporary nausea, headaches, or disrupted sleep.
Watching for Increased Distress: Because antidepressants take a few weeks to improve mood but can sometimes cause an early boost in physical energy, there is a small but critical risk of increased agitation, emotional volatility, or self-harm thoughts in the initial weeks. Parents and carers must contact the clinician immediately if they notice sudden behavioral changes.
Continuing Treatment: If the medication is successful, it is recommended to continue taking it for at least 6 months after full recovery to significantly lower the risk of the depression returning. Medication should never be stopped suddenly; it must always be phased out gradually under a doctor's guidance.

Supporting Your Child: Advice for Parents and Carers

Listen Without Judgment: Allow them to voice their feelings without immediately trying to "fix" the problem or telling them to cheer up. Validate that their pain is real to them.
Encourage Small Routines: Gently encourage a consistent sleep schedule, balanced meals, and light physical activity, as these heavily influence physical brain chemistry.
Collaborate with the School: With your child's consent, inform their school or college so that appropriate academic adjustments, extensions, or quiet spaces can be provided while they recover.
Prioritize Safety: If your child talks about self-harm or feelings of wanting to end their life, take it seriously. Keep emergency contact numbers (like your local crisis team, NHS 111, or a trusted helpline) readily accessible, and remove highly lethal items from easy reach at home.

Depression in Children and Young People: A Guide for Families