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THE ROAD AHEAD I DEPRESSION
Depression affects how a person thinks, feels, and acts—even children and teens. Explore the questions below to learn how to recognize the signs, understand causes, and find helpful treatments.
What will I notice in my child?
Children and adolescents with depression may experience some or all of these symptoms below everyday, or most of the day:
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Feeling or appearing sad, tearful or irritable
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Not being able to have fun doing things that were fun before
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Eating a lot more or a lot less than usual
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Moving around very quickly or very slowly
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Sleeping much more or much less than usual
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Having a lot less energy than usual
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Feeling like they are “no good” or guilty
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Having a hard time thinking, concentrating, or remembering
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Having thoughts about hurting or killing themselves
Something to note, younger children may have a harder time expressing their sad thoughts than older children. Be on the lookout for signs of increased irritability, boredom, and physical complaints as signs of depression for younger children.
CBT is a widely researched form of psychotherapy that has been shown to be an effective form of treatment for youth with depression. CBT focuses on how a child’s thoughts, feelings, and behaviors are interconnected. A CBT therapist will collaboratively work with your child to help them learn new skills, tools, and knowledge needed to help them improve their mood.
A CBT therapist may also work with a child’s caregivers to provide them with [PM1] resources and skills to continue to help their child after therapy ends. CBT therapy sessions that include the caregivers may be together or individual (parent alone, child alone).
CBT will likely also incorporate hands on techniques that you and your child can practice in-between treatment sessions. These in-between practices help your child generalize the lessons learned in treatment to outside of the therapy office.
Pediatric guidelines recommend CBT as a first-line treatment for those with mild depression. However, for those adolescents with more severe depression and those that have treatment-resistant depression, CBT combined with antidepressant medication may be the most effective form of treatment.
CBT alone treatment typically incorporates six to 16 weekly sessions.
Click here for more information.
Although CBT is the most widely studied psychotherapeutic intervention for adolescents, IPT is a well-established treatment that has been shown to be effective for a variety of mental health conditions.
IPT-A is a type of therapy that can help teens improve their relationships with others. The goal of IPT-A is to learn how to effectively communicate emotions and needs, problem-solve within a significant relationship, and understand the biopsychosocial explanation of depression. A biopsychosocial model emphasizes that negative or distressing events people experience can exacerbate feelings of sadness and worthlessness, both common symptoms of depression. As relationships with others improve, the depressive symptoms may subside, and the person will hopefully experience improved functioning in multiple areas of his/her life. Teens who undergo IPT-A therapy may find that they are better able to manage their depression and have more positive relationships with others.
An IPT-A therapist will focus on improving your adolescent’s communication and problem-solving skills through incorporating techniques such as psychoeducation, affect labeling, and social skills training.
IPT-A will also include techniques that your child can practice in-between treatment sessions. These in-between practices help your child generalize the lessons learned in treatment to outside of the therapy office.
The therapist will work with the adolescent in individual sessions as well as help their caregivers learn additional ways to support their child and monitor their symptoms.
IPT-A treatment typically incorporates 12 to 16 weekly sessions.
DBT, is a type of cognitive behavioral therapy that was originally developed for adults. In recent years, however, it has been adapted for use with adolescents. DBT has been proven to be an effective treatment for moderate to severe depression, as well as co-occurring disorders such as anxiety and substance abuse. It is also effective in treating self-harm and suicidal behaviors. DBT is based on CBT, but it also includes strategies for controlling emotions and handling stressful situations. As a result, DBT is a highly effective treatment for adolescents struggling with mental health issues.
DBT is particularly useful for adolescents who have difficulty managing their feelings of intense emotions and mood swings.
A DBT therapist will help your child learn skills related to emotion regulation, managing relationships appropriately, distress tolerance, mindfulness, and finding a balance within their emotional reactions.
DBT incorporates individual therapy sessions for your teen, group sessions with peers, and one-on-one coaching during emotional crises.
DBT treatment typically incorporates 1-2 sessions per week for approximately six months.
Antidepressant medication can be an effective form of treatment for children and adolescents struggling with depression. In fact, the American Academy of Child and Adolescent Psychiatry indicates that about 55-65% of children and adolescents will respond to initial antidepressant medication treatment. Also, for those that do not respond to antidepressant medication alone, research seems to suggest many youth respond well to medications combined with therapy.
Medications called selective serotonin reuptake inhibitors (SSRIs) are the primary treatment for youth with depression.Currently there are only two SSRIs that are approved by the FDA for treatment of depression for youth.
Fluoxetine (also known as Prozac) has been approved for children 8 years and older.
Escitalopram (also known as Lexapro) has been approved for adolescents 12 years and older.
Important to note, the American Academy of Child and Adolescent Psychiatry indicates that “your doctor may prescribe other antidepressant medications that are not FDA approved based on available data. You should know that prescribing an antidepressant that has not been approved by the FDA for use in children and adolescents (referred to as off-label use or prescribing) is common and is consistent with accepted clinical practice.”
Before your child starts antidepressant medication, it will be important to have your child get a thorough evaluation from a mental health professional.
This can be done by a psychiatrist – or a pediatrician or family physician who is experienced in treating children and adolescents with mood disorders.
A medication evaluation should include:
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An assessment of your child’s current emotional and behavioral concerns, particularly related to if your child potentially has multiple problem areas/diagnoses.
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An evaluation of your child’s family history of mental health and suicide concerns.
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A detailed review of any risk factors that may affect your child and increase their risk of self-harm behaviors.
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For more information related to medication management for youth with depression see the American Academy of Child and Adolescent Psychiatry’s Depression: Parents’ Medication Guide.
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Who is affected by depression?
Depression is a mental health condition that can affect people of all ages, even children. Depression is more common in adolescence, with more than half of adolescents reporting feeling depressed at some point.
However, depression can also affect younger children, even preschoolers.
Children and adolescents may not know how to talk about feeling down or worried and may become withdrawn or less cooperative or irritable.
Treatments that work for depression
ADVOCATING FOR HELP I DEPRESSION
Getting support for Depression starts with knowing what to ask for. Use the questions below to find out how to get help, talk with providers, and access the tools your child may need.
How to get help
If you’re worried your child might be depressed, trust your instincts—it’s important to reach out for help early. Start by talking to your child’s pediatrician or primary care provider. They can listen to your concerns, do a basic screening for depression, and refer you to a mental health professional if needed. You can also contact a child therapist, psychologist, or psychiatrist directly. These professionals are trained to assess your child’s emotional wellbeing and provide support through therapy, and in some cases, medication. If your child is in school, you can also talk to a school counselor or social worker—they may help connect you with local resources. You don’t have to have all the answers to start; reaching out is the first—and most important—step.
What is a psychological assessment?
If you’re worried your child might have Depression, talk to their doctor. The doctor may recommend a full psychological assessment to better understand what’s going on. This usually includes talking with you, your child, and sometimes teachers or others who know your child well. The assessment often involves interviews, questionnaires, and tests that help show your child’s strengths, challenges, and how they’re doing at home, school, and with friends.
Learn more here.
How can I get a comprehensive psychological assessment for my child?
Depending on your particular need, you may seek a psychological assessment from your school’s psychologist (if you are seeking IEP/504 accommodations) and/or outside providers.
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Click here for more information on how to seek a psychological assessment through your school.
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Click here for a sample letter of how to request that your child receive an evaluation for special education services.
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Click here for a list of providers in your area that conduct psychological assessments.
If you are a parent seeking resources from your school, it is important to highlight that when requesting an IEP from your school, you do have the right to have your child evaluated by an outside professional other than your school’s psychologist. To note, in many of these cases, you will have to pay for the private evaluation. Furthermore, while the school must consider the evaluation from the outside provider, they do not necessarily have to accept the results.
If my child has depression, what treatment components should I ask my provider about?
When someone experiences depression they can tend to isolate themselves from others around them. Often times this isolation increases their feelings of depression, causing further isolation and reducing the amount of time they spend doing activities that bring them joy.
Activity scheduling, also known as behavioral activation, is an evidence-based technique that involves helping a child regularly engage in activities that they enjoy. The goal of activity scheduling is to reduce a child’s feelings of depression and increase their mood.
The key to activity scheduling is finding activities that are rewarding to the child and foster their personal values. It has also been shown to be helpful to incorporate activities that are physically engaging (e.g., exercise instead of playing video games) and have a social component (e.g., spending time with friends/family).
Some examples of activities can be:-
Exercise: Going on a hike with a friend, playing soccer, skiing
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Relationship building: Going to a friend’s house, joining after-school programs
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Activities in the community: Try to identify your child’s interests and link those to groups, clubs, and/or teams in your community (e.g., Scouts, dance)
Here’s a resource to help with planning.
Parents can:-
Help your child find and regularly do activities they enjoy.
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Join your child in the sport, game, or whatever, whenever possible.
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Encourage your child by saying what you see them do or accomplish:
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“I saw you hit that basket from way downtown. Wow, way to go!”
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“You seriously swam across that pool and back 5 times? I’m impressed!”
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“I’m looking at this painting and seeing red, blue, purple—so many colors that make my eyes feel happy and proud of your good work!”
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Look for signs that the regular activities are helping:-
Has your child’s mood improved?
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Is your child more comfortable and positive about going out and doing things?
What should I be looking for from my therapist?-
Your therapist should be:
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Helping your child understand how engaging in different activities can change how they feel
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Working with your child to identify different activities that they may enjoy
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Helping you and your child learn bhow to schedule making these pleasant activities a part of their day/week
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Using hands on techniques to help you child understand how certain activities can increase their mood
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Helping your child identify any mood changes as they start to incorporate more pleasant activities into their schedules
What can I do be doing as a caregiver?
You can:-
Support your child to engage in new and enjoyable activities
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Participate in activities with your child
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Reward and praise your child as they engage in these new activities
Looking for signs this is working:
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You may see: Your child’s mood improves
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As your child starts to engage more in these activities, they may feel more comfortable and positive about doing these activities.
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Often times our thoughts can affect how we feel. As an example, when we have more negative thoughts (e.g., “I’m no good at anything.”), we tend to feel more negatively (e.g., sad, frustrated). Cognitive techniques help a child change their thoughts by understanding the meaning they are giving the situation/event.
This technique is often done through a child keeping a record of the different thoughts they have (e.g., “thought record”) during a given period.
When incorporating cognitive techniques into treatment, a therapist will work with your child to help them recognize patterns of thinking and identify ways to test the potential accuracy of these thoughts.
The goal of cognitive techniques is to help children change their thoughts into more positive, helpful thoughts that increase their mood ratings.
What should I be looking for from my therapist?
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Working with your child to recognize their current thought patterns
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Helping your child question the accuracy of their current thoughts
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Assisting your child create more realistic thoughts
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Tracking your child’s mood as they progress through treatment
What can I do be doing as a caregiver?
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Help your child by recognizing when they may be having an unrealistic negative thought
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Help your child create a more realistic thought
Looking for signs this is working:
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Your child may start to better recognize when they are having a negative thought
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Your child may be able to identify when a thought affects their mood
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Your child’s mood improves
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Your child may start to use coping skills they are learning in treatment that help them combat their negative thoughts
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Your child may start to use coping skills they are learning in treatment that help them combat their negative thoughts
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Life can be stressful at times, particularly for youth with mood disorders. Finding ways to relax that works for your child can be a very helpful tool to help them cope during difficult times and improve their mood.
Relaxation techniques are typically done with a therapist at first, in order to help your child learn how to effectively practice and use the tools.
Such tools can include deep breathing activities, progressive muscle relaxation, guided imagery, and/or meditation. It’s important to note that all relaxation techniques work for every child, so it will be helpful for your child’s therapist to identify which techniques work best for them.
What should I be looking for from my therapist?
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Educating your child about how physical feelings in your body can affect your emotions
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Teaching your child different relaxation techniques
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Practicing relaxation techniques with your child
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Tracking your child’s mood ratings as they practice relaxation techniques
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Helping your child practice the relaxation techniques outside of treatment sessions (e.g., at school, at home)
What can I do be doing as a caregiver?
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Help your child practice their relaxation techniques
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Praise your child when their use their relaxation techniques
Looking for signs this is working:
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That your child is less stressed or tense
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That your child voluntarily uses relaxation techniques when they are sad or stressed
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PROGRESS OVER TIME I DEPRESSION
This section offers a few extra tools to help you along the way. Whether things are going smoothly or getting more challenging, these resources can support you as your child grows and their needs change.
My child has depression, now what?
Once your child has started therapy or medication for depression, you might wonder how to keep supporting them at home and in everyday life. Here are some next steps that can make a meaningful difference:
Just know that you don’t have to figure this out alone. Programs like Incredible Years, Triple P, or Parent-Child Interaction Therapy (PCIT)* offer step-by-step tools to manage challenging behaviors and strengthen your relationship with your child. Also feel free to take a look at our Parent Toolkit-ADHD for additional ideas/resources.
Books like The Whole-Brain Child by Dan Siegel & Tina Payne Bryson, Helping Your Depressed Child by Martha Underwood Barnard, or When Your Child Is Depressed by Dr. Michael D. Yapko offer practical advice for understanding depression and building a stronger emotional connection.
Groups through organizations like NAMI (National Alliance on Mental Illness) or local children’s hospitals offer spaces for parents to learn from others, share strategies, and feel supported. For older children and teens, peer support programs like YouthLine or Teens Helping Teens can be safe, encouraging options.
Tools like the RCADS-25-P/C (a brief depression screener) can be filled out regularly to track symptoms and make sure your child’s treatment is working. These can help catch changes early and guide what adjustments might be needed in therapy or medication.
Depression can affect attention, energy, and academic performance. Ask about creating or updating a 504 plan to include mental health accommodations—like extra time on assignments, modified workloads, or check-ins with a school counselor.
You’re not starting from scratch—you’re building on the care your child is already receiving. These steps can help you feel more equipped and connected as you continue the journey together.
My child is getting worse, what can I do?
It’s hard to see your child struggling, especially when things seem to be getting worse instead of better. You're not alone, and there are important next steps you can take. Start by letting your child’s provider know what you're seeing—changes in mood, sleep, appetite, or behavior. They may adjust the treatment plan, recommend more frequent therapy, or suggest a medication review. You can also ask about creating a crisis or safety plan, which outlines clear steps to take during tough moments. If symptoms are affecting school or home life more intensely, consider layering in tiered supports like in-home therapy, intensive outpatient programs (IOP), or updated school accommodations. Most importantly, if you are ever worried about your child’s safety, don’t wait—call or text 988 for immediate help from trained mental health professionals. Getting worse doesn’t mean starting over—it means it’s time to reassess, lean on your team, and make sure the right supports are in place.
Talking with my child’s school
Depression can impact your child’s energy, focus, motivation, and ability to manage the demands of school. If you're noticing these struggles, it’s important to partner with the school early. You can request a meeting to discuss academic or emotional concerns and ask about a 504 plan or IEP for support. These plans can offer accommodations like reduced homework, flexible deadlines, or regular check-ins with a counselor. Bringing a behavioral health consultant or educational advocate to school meetings can also help you understand data, shape meaningful goals, and communicate more clearly with the team. Resources like Understood.org and Wrightslaw can help you know your rights and learn how to advocate effectively. You don’t have to figure this out alone—and the school can be an important partner in your child’s care.
CAREGIVER TOOLKIT I DEPRESSION
This section offers simple, practical tools to help you support your child—from building routines and healthy habits to improving communication and recognizing their strengths. It’s also a reminder that taking care of yourself is part of the plan—you’re not alone on this journey.
Daily habits that help
Encourage your child to talk with you and/or a grown-up they trust.
Creating a supportive environment that allows your child to have open and healthy conversation with you will help them overcome their depression.
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Help your Child Practice Their New Skills
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Understand the Skills Your Child is Learning
You are an essential part of your child’s treatment. It will be important for you to work with your child’s therapist to understand the skills and strategies that your child is learning in treatment.
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Caring for a child with depression can feel heavy at times. It’s okay to feel overwhelmed, and it’s more than okay to ask for help. In fact, modeling that it’s safe to reach out is one of the most powerful lessons you can give your child.
You don’t have to carry this alone. Lean on your support system—friends, family, therapists, or parent support groups—and take breaks when you can. Taking time for yourself is important, even if it’s just asking a friend or family member to watch your child for a short walk or some quiet time. Caring for yourself allows you to show up with more steadiness and warmth, which helps your child feel more secure.
Progress with depression often takes time, and there will be ups and downs. Celebrate the small wins—for both your child and yourself. Find moments of joy or rest: a walk, a favorite book, a quiet coffee, or a shared activity with your child. These aren’t luxuries—they’re part of the work.
Parenting through depression is hard, but you’re doing it. Keep going. And when you need it, let others help you move forward too.
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