Learning to balance life’s positive experiences and emotions with the unhappy ones is an important part of growing up, but some children find this to be a struggle. An estimated 3.2 percent of American children and adolescents have diagnosed depression. And while depression was long seen as an adult problem, researchers now know that even a 2-year-old can experience depression.

As children get older, some of those who suffer from depression have thoughts of killing themselves, a condition otherwise known as suicide ideation. Such thoughts can be fleeting ideas that suicide may be a solution to a situation (such as a painful breakup), or they may be more carefully thought out plans on how to make it happen.

At Yale Medicine Child Study Center, our highly trained clinicians have extensive experience delving into the environmental contexts of child depression, including family influence. We work with families to properly diagnose an array of mental health concerns among children and treat them. 

Depression may be diagnosed when a child or teen has persistent feelings of sadness that interfere with the ability to function. Loss, stress, co-occurring mental health conditions (such as ADHD or anxiety), and a family history of depression raise the odds that a child may experience depression.

In survey of students at U.S. high schools, 10 percent of boys and 22 percent of girls reported suicide ideation in the previous year, says Yann Poncin, MD, a child psychiatrist and assistant professor at the Child Study Center. He calls it “common in the context of depression.” Though many kids have these thoughts, most don’t act on them, says Dr. Poncin, but even so, the symptom should be taken seriously, he says.

Depression can look very different from one child to the next. When a provider makes a diagnosis, it’s important to focus on what’s normal for a particular child. Symptoms that may suggest depression include: 

• “Acting out” behaviors, ranging from oppositional defiance to disruptiveness
• Anger or irritability
• Anxiety
• Difficulty at school, including changes in grades or refusing to attend
• Fatigue and sleep difficulties, including trouble falling asleep, staying asleep or wanting to sleep much more than is usual
• Feelings of worthlessness, restlessness, or low self-esteem
• Loss of pleasure from friends, family, or activities the child once enjoyed
• Mood disruptions, such as mood swings or pervasive sadness that is out of proportion to a situation or that persists and overwhelms a child
• Physical complaints, such as headache; digestive complaints, including loss of appetite, and other aches and pains 

Adolescents may experience the same symptoms along with others, such as:

• Isolation
• Preoccupation with song lyrics, books, poetry, or art that suggest that life is meaningless
• Significant change in weight, loss or gain
• Thoughts of death or suicide

Less frequently, some children and teens may show more extreme symptoms, such as:

• Paranoid delusions
• Auditory hallucinations
• Self-harming behaviors, such as cutting

Because depression treatment is always individualized, strategies are very different for a 4-year-old than they are for a 14-year-old. Typically, the best approach is psychotherapy, most often in the form of cognitive behavioral therapy (CBT), which teaches the use of new, more effective strategies to regulate their emotions, thoughts, and behaviors. Often, parents participate in the psychotherapy.

For children whose depression doesn’t respond to psychotherapy, medication can be an option. According to Laine Taylor, DO, associate medical director of the Yale New Haven Hospital Child Psychiatry Service and an expert in medication management for children, the goal with children (especially in the preschool and grade-school years) is “to use the fewest medications at the lowest effective dose.” A form of antidepressant medication called selective serotonin re-uptake inhibitors (SSRIs) is FDA-approved for use by adolescents and teens and often brings improvement.

Widely known for extensive research and expertise in mental health disorders that affect children, the Yale Medicine Child Study Center treats children with severe mental illness, including those who have experienced trauma. The knowledge and experience gained from these challenging cases contribute to broad expertise and a deep commitment to helping children move past depression and into happier, more productive lives.

Poncin says that treating “the illest of ill children” leads to deep insight into complex and sensitive issues surrounding pediatric mental health care. The Child Study Center uses highly detailed clinical guidelines, sorting out which therapeutic approach is most likely to help a particular type of depression, and understanding how to safely treat children already on other medications for co-occurring conditions.

Additionally, the Child Study Center has wide experience in developing, refining and applying a variety of evidence-based therapies. For example, if cognitive behavioral therapy proves ineffective for a child, other types of psychotherapy may be more beneficial.

The Child Study Center offers a unique combination of advanced, leading-edge science and deep insight into the environmental context of child depression, including the influence of family. “Understanding the generational components to treatment, we offer family-centered therapy combined with an understanding of how a child’s individual biology and symptomatology contribute to depression,” Dr. Poncin says.