Depression | BH360

My child may

have Depression

- now what?

Click a destination to learn more.

Understanding Depression

Children and adolescents with depression may experience some or all of these symptoms below everyday, or most of the day:

Feeling or appearing sad, tearful or irritable
Not being able to have fun doing things that were fun before
Eating a lot more or a lot less than usual
Moving around very quickly or very slowly
Sleeping much more or much less than usual
Having a lot less energy than usual
Feeling like they are “no good” or guilty
Having a hard time thinking, concentrating, or remembering
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.

Research suggests that depression has a genetic component. Depression is more common among kids who have a family history of the condition, and it is believed that certain genes may make some people more vulnerable than others. While the presence of these genes does not guarantee that a person will develop depression, it does increase the risk.

Additionally, stress can also play a role in both the onset and severity of depression. Stress can come in all different forms and might include:

Difficulties with peers
Family relationship challenges
School changes
Loss of a loved one
Developmental factors (such as learning and language disabilities)

Puberty can also be an additional time of stress for an adolescent. During this time, it's normal for children to experience some ups and downs during. After all, they're going through a lot of changes both physically and emotionally. However, for some children, these changes can be overwhelming and can lead to depression and anxiety. Adolescents are likely to react more emotionally due to their stage of brain development and the fact that they don't yet have effective problem-solving skills. With the support of family and friends, most children will eventually adjust to the changes they are experiencing and emerge from puberty unscathed. However, if you are concerned about your child’s emotional well-being, don’t hesitate to seek professional help.

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

Cognitive Behavioral Therapy (CBT)

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.

Interpersonal Psychotherapy-For Adolescents (IPT-A)

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.

Dialectical Behavioral Therapy (DBT)

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.

Medications

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:

An assessment of your child’s current emotional and behavioral concerns, particularly related to if your child potentially has multiple problem areas/diagnoses.
An evaluation of your child’s family history of mental health and suicide concerns.
A detailed review of any risk factors that may affect your child and increase their risk of self-harm behaviors.
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.

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.

Understanding

Depression

Depression is a mood disorder that causes persistent sadness and loss of interest in things someone used to enjoy. Clinical depression affects how a person feels, thinks, and behaves and can show up in a variety of ways. It often occurs as both emotional (e.g., sadness, irritability) and physical symptoms (e.g., difficulties sleeping, weight loss).

As a parent, it's important to be able to recognize when your child is experiencing normal feelings of sadness, and when they may be dealing with something more serious. Sad thoughts are a normal part of life, and everybody experiences them from time to time. However, if your child is having difficulty in school, or withdrawing from friends and family, it could be a sign of something more serious.

In such cases, it's important to seek professional help. A qualified mental health professional can assess your child's symptoms and provide the necessary support and treatment. With the right help, your child can begin to feel better and get back on track.

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.

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.

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 one 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.

Click here for more information on how to seek a psychological assessment through your school.

Click here for a sample letter of how to request that your child receive an evaluation for special education services.

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.

ACTIVITY SCHEDULING

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
Relationship building: Going to a friend’s house, joining after-school programs
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.

More about Activity Scheduling Parents can:

Help your child find and regularly do activities they enjoy.
Join your child in the sport, game, or whatever, whenever possible.
Encourage your child by saying what you see them do or accomplish:
“I saw you hit that basket from way downtown. Wow, way to go!”
“You seriously swam across that pool and back 5 times? I’m impressed!”
“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!”

Look for signs that the regular activities are helping:

Has your child’s mood improved?
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:
Helping your child understand how engaging in different activities can change how they feel
Working with your child to identify different activities that they may enjoy
Helping you and your child learn bhow to schedule making these pleasant activities a part of their day/week
Using hands on techniques to help you child understand how certain activities can increase their mood
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
Participate in activities with your child
Reward and praise your child as they engage in these new activities

Looking for signs this is working:

You may see: Your child’s mood improves
As your child starts to engage more in these activities, they may feel more comfortable and positive about doing these activities.

COGNITIVE WORK

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?

Working with your child to recognize their current thought patterns
Helping your child question the accuracy of their current thoughts
Assisting your child create more realistic thoughts
Tracking your child’s mood as they progress through treatment

What can I do be doing as a caregiver?

Help your child by recognizing when they may be having an unrealistic negative thought
Help your child create a more realistic thought

Looking for signs this is working:

Your child may start to better recognize when they are having a negative thought
Your child may be able to identify when a thought affects their mood
Your child’s mood improves
Your child may start to use coping skills they are learning in treatment that help them combat their negative thoughts
Your child may start to use coping skills they are learning in treatment that help them combat their negative thoughts

RELAXATION SKILLS

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?

Educating your child about how physical feelings in your body can affect your emotions
Teaching your child different relaxation techniques
Practicing relaxation techniques with your child
Tracking your child’s mood ratings as they practice relaxation techniques
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?

Help your child practice their relaxation techniques
Praise your child when their use their relaxation techniques

Looking for signs this is working:

That your child is less stressed or tense
That your child voluntarily uses relaxation techniques when they are sad or stressed

Advocating

for Help

Getting the right support for your child with Depression can feel overwhelming, but you don’t have to do it alone. This section guides you through how to start the conversation with professionals, understand what a thorough assessment looks like, and recognize key treatment components that make a difference. You’ll also find practical tips for working with your child’s school to secure accommodations and how to find the right providers to support your family’s unique needs. We’re here to help you confidently advocate for the care your child deserves. 

Progress

Over Time

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:

Take part in parent-focused training or coaching. Programs like SPACE (Supportive Parenting for Anxious Childhood Emotions) or CBT-based parent coaching can help you learn how to respond to withdrawal, mood changes, or low motivation in ways that support your child’s progress without reinforcing avoidance.

Read evidence-based books to guide your parenting. 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.

Connect with community or peer support groups. 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.

Ask your provider to use measurement-based care. 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.

Collaborate with your child’s school. 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.

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'reseeing—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.

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 IEPfor 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 advocateto school meetings can also help you understand data, shape meaningful goals, and communicate more clearly with the team. Resources like Understood.organdWrightslaw 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.

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.

You’re doing important work. By showing up, paying attention, and seeking support, you’re already making a difference in your child’s life. Supporting a child with depression can feel like a journey with unexpected turns—some days are easier than others—but you’re not alone on the path. This section offers a few extra tools to help you along the way: ways to build on the care your child is already receiving, support for the tougher moments, and guidance for working with schools and providers. Every step you take matters—and you’re already helping your child move toward healing and hope.

Progress Over Time

Advocating For Help

Parent Toolkit

Caregiver Tool Kit

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.

Help your Child Practice Their New Skills
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.

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.

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.

Supporting a child with depression takes compassion, consistency, and the right tools to help them feel safe, understood, and connected. This section offers practical strategies you can use at home—like creating gentle routines, improving emotional communication, and helping your child feel a sense of purpose and connection. You’ll also find tips for encouraging healthy habits, supporting their motivation, and caring for your own well-being along the way. You don’t have to have all the answers—you just have to keep showing up. This toolkit is here to support you, one small step at a time.

What will I notice in my child?

What causes depression?

Who is affected by depression?

Treatments that work for depression

How to get help

What is a psychological assessment?

How can I get a comprehensive psychological assessment for my child?

If my child has depression, what treatment components should I ask my provider about?

Find a Provider

My child has Depression, now what?

My child is getting worse, what can I do?

Talking with my child’s school

Communication Strategies

Caregiver Self-Care

Find a Provider