Depression in children and adolescents goes far beyond occasional sadness. It can profoundly affect emotional, academic, social and family development, interfering with self-esteem, relationships and quality of life.

Early detection and specialized intervention are crucial to prevent symptoms from worsening and to favour adequate recovery.

How does depression manifest in children and adolescents?

Temporary emotional estate changes, which last a few days and are usually related or are a consequence of situations that are stressful.

Feeling sad is normal, and even more in adolescence, which is a developmental period in which it is common to experience mood changes. Sadness, although it may be unpleasant or uncomfortable, has an important function: helping us process, work through and face painful situations. This fosters reflection and personal growth. Therefore, sadness can be an emotional discomfort reaction considered normal in difficult situations.

Sadness becomes a mental health problem when it is prolonged over time in a persistent and intense way, interfering with daily life.

In childhood and adolescence, it can be expressed in a different way compared with adult depression.

While some adolescents show intense sadness, apathy or isolation, in children it is common for distress to appear through:

• Constant irritability.
• Frequent anger or tantrums.
• Defiant behaviour's.
• Loss of interest in usual activities.
• Progressive social isolation.
• Decrease in school performance.

Many adolescents with depression report feeling:

• Empty or emotionally disconnected. Hopeless.
• With low motivation and interest in activities they used to enjoy.
• Misunderstood or guilt. Feeling loneliness.
• More irritable.
• Excessively demanding of themselves.
• Mentally and emotionally exhausted.
• More unfocused and with more difficulties making decisions.

Sometimes, adolescent depression is related to high levels of self-demand and perfectionism, generating a constant feeling of failure, fear of disappointing others, and low self-esteem.

Frequent symptoms of child and adolescent depression

Symptoms may vary according to age and developmental stage, but the most common include:

Emotional symptoms

• Persistent sadness. Low mood.
• Irritability or sudden mood swings.
• Low self-esteem.
• Feeling of worthlessness or excessive guilt.
• Hopelessness or negative view of the future.
• Sensitivity to rejection.
• Crying.
• Feeling helplessness.

Cognitive symptoms

• Difficulty concentrating.
• Mental blockage. Self-criticism.
• Recurrent negative thoughts. Feelings of worthlessness or guilt.
• Greater difficulty making decisions.

Physical and behavioural symptoms

• Fatigue or loss of energy.
• Sleep disturbances (insomnia or excessive sleep).
• Changes in appetite or weight.
• Withdrawal or social isolation.
• Loss of interest in activities they previously enjoyed.
• Psychomotor slowing or intense restlessness.
• Drop in academic performance

In some cases, the following may appear:

• Thoughts of death.
• Suicidal ideation.
• Self-harm

Some adolescents may use self-injurious behaviour as a way of managing emotional distress. Adolescents may use physical pain to try to reduce, manage, or escape from these feelings such as sadness or anger, which they experience in a very unpleasant way and in many cases explain that they do not feel capable of facing such an intense emotion.

Warning signs are seeing cuts, burns, scratches or unjustified blows that they cannot explain. Wearing clothing that is not appropriate for the season or temperature, refusing to do activities that involve changing clothes, wearing bandages or always keeping wrists covered, verbalizing ideas related to self-harm, finding sharp objects.

Non-suicidal self-harm does not always imply a desire to die, but it does indicate high emotional suffering and requires specialized assessment.

Risk factors in adolescent depression

Child and adolescent depression usually appear through the interaction of multiple factors:

• Previous anxiety.
• Perfectionism and high self-demand.
• Low self-esteem.
• Bullying or social difficulties.
• Academic stress.
• Family conflicts or difficult life situations.
• Behavioral of rejection, loss, or trauma.