Depression and persistent low mood can affect children and young people in different ways. Some become noticeably sad, withdrawn or tearful, while others appear irritable, angry, exhausted or unusually quiet. Changes in sleep, appetite, concentration, school attendance, friendships and enjoyment may be just as important as mood. Early assessment can help clarify what is happening and identify the right level of support.
What is depression in young people?
Depression is more than an occasional period of sadness or a difficult response to everyday disappointment. It is a mental health condition in which low mood, loss of interest or reduced enjoyment persist and begin to interfere with a young person’s relationships, education, family life or daily functioning.
Young people may find it difficult to describe their emotional experience. They may say they feel “blank”, “stressed”, “tired” or that they “cannot be bothered”, rather than identifying sadness. Depression can occur after stressful events, but it can also develop without an obvious trigger. It may occur alongside anxiety, autism, ADHD, eating difficulties, self-harm, sleep problems or physical health conditions.
Persistent low mood does not mean that a child or teenager is being difficult, lazy or attention-seeking. It is a genuine health concern that deserves a thoughtful, non-judgemental assessment.
Signs and symptoms to look out for
The presentation of depression varies with age, temperament and circumstances. Possible signs include:
- Persistent sadness, emptiness, hopelessness or irritability
- Loss of interest in hobbies, friends, family activities or previously enjoyable experiences
- Low energy, tiredness or moving and speaking more slowly
- Difficulty concentrating, making decisions or completing schoolwork
- Changes in sleep, including insomnia, early waking or sleeping much more than usual
- Changes in appetite, eating patterns or weight
- Feelings of worthlessness, excessive guilt or being a burden
- Withdrawal from friends, reduced communication or spending much more time alone
- Declining school attendance, academic performance or motivation
- Increased irritability, anger, arguments or emotional outbursts
- Physical complaints such as headaches, stomach aches or general aches without a clear medical explanation
- Thoughts about death, disappearing, self-harm or suicide
A younger child may become clingy, lose confidence, stop playing or show developmental regression. An adolescent may conceal symptoms, continue to meet some responsibilities or communicate distress through risk-taking, substance use, self-harm or conflict at home. Symptoms should be considered in the context of the young person’s usual behaviour and circumstances.
When should you seek an assessment?
It is appropriate to seek professional advice when low mood is persistent, worsening, difficult for the family to manage or affecting education, relationships, sleep, appetite or self-care. An assessment is particularly important if the young person is self-harming, expressing hopelessness, talking about suicide, giving away possessions, saying goodbye, or showing a sudden change in behaviour.
If there is immediate concern that a young person may act on suicidal thoughts, they should not be left alone. Remove access to means of harm where possible and seek urgent help through NHS urgent and emergency services, 111, or 999 in an emergency. A consultant assessment is not a substitute for immediate emergency care.
How is depression assessed?
A careful assessment explores the young person’s emotional symptoms, thoughts, behaviour and functioning over time. It will usually include a confidential discussion with the young person, alongside information from parents or carers and, where appropriate, school or other professionals. The clinician will explain confidentiality and its limits, including the need to share information if there is a significant risk of harm.
Assessment may consider:
- When symptoms began, how they have changed and what makes them better or worse
- The impact on home life, friendships, education, activities and self-care
- Sleep, appetite, energy, concentration and physical symptoms
- Self-harm, suicidal thoughts, plans, intent and access to means
- Anxiety, obsessive-compulsive symptoms, trauma, eating difficulties or substance use
- Attention, impulsivity, sensory needs and social communication differences
- Family history of depression, bipolar disorder or other mental health conditions
- Stressors such as bullying, bereavement, family conflict, abuse, neglect or online experiences
- Physical health, medication, menstrual or hormonal factors and possible medical causes
There is no single blood test that diagnoses depression. Questionnaires can help measure symptoms and track change, but they do not replace clinical judgement. The clinician will also consider alternative or co-existing explanations, including anxiety, adjustment difficulties, autism-related burnout, ADHD, sleep problems, thyroid conditions, anaemia, medication effects and bipolar disorder. Identifying periods of unusually high or irritable mood, reduced need for sleep, increased activity or impulsive behaviour is particularly important before considering antidepressant treatment.
Treatment options for depression and low mood
Treatment is tailored to the young person’s age, symptoms, preferences, developmental needs, family situation and level of risk. The National Institute for Health and Care Excellence (NICE) guideline Depression in children and young people: identification and management (NG134) recommends a stepped approach, with psychological therapy central to treatment.
Psychological therapies
For many young people, talking therapy is the first treatment option. Cognitive behavioural therapy (CBT) can help identify patterns between thoughts, feelings and behaviour, and develop practical strategies for coping, problem-solving and gradually returning to valued activities. Other approaches may include interpersonal therapy, family-focused work or behavioural activation, depending on the assessment.
Therapy may involve parents or carers, particularly for younger children or where family communication, routines or safety planning are important. It should be adapted for neurodevelopmental differences, communication style, learning needs and cultural context.
Practical and family support
Helpful measures can include a consistent sleep routine, regular meals, gentle physical activity, manageable daily structure and maintaining safe social contact. These steps are not a replacement for treatment, but they can support recovery. Families may also need guidance about responding to distress, reducing conflict, communicating openly and making a safety plan.
Medication
Antidepressants are not usually the first treatment for mild depression. For moderate to severe depression, medication may be considered alongside psychological therapy, particularly when symptoms are persistent, significantly impairing or have not improved sufficiently with therapy alone. Fluoxetine is the antidepressant most commonly recommended in NICE guidance for young people when medication is indicated. Other medicines may be considered by a specialist in particular circumstances.
Medication should be prescribed and monitored by an appropriately experienced clinician. Families should receive clear information about possible benefits and side effects, including any increase in agitation, emotional distress or suicidal thoughts after starting or changing medication. Regular follow-up is essential, especially during the early stages of treatment. Antidepressants should not be stopped suddenly without medical advice.
Assessment and treatment at Healing Young Minds
At Healing Young Minds, a Consultant Child and Adolescent Psychiatrist can provide a comprehensive assessment of depression and persistent low mood. We consider the whole picture rather than focusing only on symptoms, including neurodevelopmental needs, physical health, family circumstances, education and safety.
Following assessment, we can discuss a clear formulation and treatment plan. This may include psychological therapy recommendations, practical strategies, liaison with other professionals and, where appropriate, advice about medication and ongoing monitoring. Our aim is to help young people and their families understand what is happening and feel confident about the next steps.
Contact Healing Young Minds
If your child or teenager is experiencing persistent low mood, loss of interest, withdrawal or concerning changes in behaviour, contact Healing Young Minds to discuss an assessment. Visit healingyoungminds.com to find out more about our Depression & Low Mood service and how we can help.