Depression in Children and Teenagers: The Signs Parents Miss and the Treatments That Work

Adults usually recognise depression as sadness. In children and teenagers it often looks different: a short temper, constant stomach aches, a child who stops seeing friends, or grades that slide for no obvious reason. Because the signs are easy to put down to a phase, depression in young people is frequently missed for months.

It is more common than many parents expect. Before puberty it is relatively uncommon, but in the teenage years it becomes one of the most frequent health problems, affecting a substantial share of adolescents at some point. The good news is that it responds well to treatment, especially when caught early.

This guide covers how depression shows up at different ages, what raises the risk, how it is assessed, what treatment involves, including medicines and their warnings, and what parents can do at home.

🔍 What it looks like at different ages

What turns normal ups and downs into depression is the combination of duration and impact. Most signs are present most days for at least two weeks, and they are getting in the way of school, friendships or family life.

🚨 Warning signs that need action now

🧩 What raises the risk

Depression rarely has a single cause. It usually grows from a mix of inherited tendency and what is happening in a young person's life.

• 🧬 A parent or sibling with depression or bipolar disorder
• 💔 Loss — bereavement, parental separation, moving away from friends
• 🚫 Bullying, in person or online
• ⚠️ Abuse, neglect or violence at home
• 🏥 Long-term illness or disability
• 🧠 Other conditions such as anxiety, ADHD or learning difficulties
• 😴 Poor sleep, often linked to late-night screen use
• 🍺 Alcohol and drugs, which both worsen mood and are used to escape it
• 🏳️‍🌈 Feeling rejected, for example young people who face hostility about their identity

🩺 What else it could be

Some physical problems cause tiredness, low mood and poor concentration. A doctor will usually check for an underactive thyroid, anaemia, and sleep disorders. Medicines can play a part too. Montelukast, used for asthma and allergies, carries a warning about mood changes, nightmares and, rarely, suicidal thoughts in children and adults. If mood changed after starting it, tell the doctor. In our catalogue it is Singulair (Montelukast). Steroid tablets can also affect mood.

Periods of very high energy, little need for sleep and racing ideas between episodes of low mood, especially with a family history, may point to bipolar disorder. That changes treatment, because antidepressants alone can make it worse.

💬 How depression is assessed

There is no blood test for depression. A doctor or mental health professional talks with the young person, often partly alone, and with parents. They ask about mood, sleep, appetite, school, friendships, and safety, including thoughts of self-harm. Questionnaires can help track severity over time. Information from school is often useful.

Teenagers are more likely to be open if they are given some time on their own with the clinician and told what will and will not be kept confidential.

🧠 Treatment: talking therapy first

For mild depression, the first step is often a few weeks of support and monitoring, along with help with sleep, activity and any stress such as bullying. Many young people improve with this alone.

For moderate to severe depression, or when mild depression does not improve, the main treatments are structured psychological therapies. Cognitive behavioural therapy and interpersonal therapy have the strongest evidence, and family-based approaches help too, particularly for younger children. What therapy involves, and how to choose a therapist, is explained in our guide to child therapy.

💊 When medicine is considered

Antidepressants are considered for moderate to severe depression in teenagers, and occasionally in younger children, usually alongside therapy rather than instead of it. They are started by, or with advice from, a specialist.

In our antidepressants category, escitalopram is available as Lexapro (Escitalopram) and sertraline as Sertafine (Sertraline). What the first weeks on escitalopram are actually like is described in our escitalopram guide.

• Improvement takes time — usually two to six weeks, with sleep and energy often improving before mood
• Side effects such as nausea, headache, trouble sleeping or feeling restless usually settle in the first weeks
• Treatment continues for at least six to twelve months after recovery to prevent relapse
• Never stop suddenly — the dose is reduced gradually

🏠 What parents can do

Listen more than you fix

Try "that sounds really hard" rather than "cheer up" or a list of solutions. Being taken seriously is often a relief.

Keep routines steady

Regular meals, wake-up times and some daily activity help mood, even when motivation is low.

Protect sleep

Phones out of the bedroom at night makes a real difference for many teenagers.

Encourage movement and daylight

A walk together counts. Exercise has a genuine antidepressant effect.

Talk to the school

Teachers can adjust workload and watch for bullying.

Lock away medicines

Store all medicines, including paracetamol and prescribed antidepressants, securely, and keep only small amounts at home. This is one of the most effective safety steps a family can take.

Look after yourself

Supporting a depressed child is exhausting. Parents need support too.

📅 Recovery and relapse

Most young people recover from an episode of depression within months with the right help. Depression can return, though, especially at times of stress or change, so knowing the early signs matters. Keeping up the habits that helped, and returning to therapy or the doctor quickly if signs reappear, prevents a full relapse. Our guide on preventing depression covers this, and depression that returns every winter is covered in our guide to seasonal depression.

📞 When to seek help

• Talk of suicide, self-harm or a plan — same day, emergency services if in danger
• Low or irritable mood most days for two weeks or more
• Refusing school, withdrawing from friends, or grades falling sharply
• Big changes in sleep or appetite, or weight loss
• Using alcohol or drugs to cope
• Worsening mood or agitation after starting an antidepressant — contact the prescriber promptly
• Mood changes after starting a new medicine, such as montelukast

❓ Frequently asked questions

📑 Sources and editorial

• Clinical guidance on depression in children and young people
• Trials of psychological therapies and antidepressants in adolescent depression
• Regulatory warnings on antidepressants and suicidality in young people
• Regulatory safety communication on montelukast and neuropsychiatric events
• Guidance on means restriction and suicide prevention in young people
• Related reading: child therapy, escitalopram, preventing depression
• Related products: Lexapro (Escitalopram), Sertafine (Sertraline)
• RXshop Editorial Team — reviewed by Thomas Walsh, MD, Psychiatry