Depression and Bipolar Disorder in Children and Adolescents

Grouchy, sulky, listless, uncooperative, and reluctant to go to school—these can all be normal behaviors in children and adolescents. But sometimes they can signal something more serious: depression or bipolar disorder. It wasn't until about twenty years ago that these disorders in children and adolescents were recognized at all. Now we know that as many as 5% of all adolescents are suffering from serious depression at any one point in time, and approximately 20% of adolescents will experience meaningful symptoms of depression by the time they enter adulthood. We also know that the peak ages of onset are 15–24 for those who develop Major Depressive Disorder.

Fortunately, depression in young people, just like adults, can be diagnosed and treated. Safe and effective treatments are available and almost always include a combination of talk therapy and medication. And the good news is that the earlier in life that depression is diagnosed and treated, the greater the likelihood of achieving remission and the less severe it will be later.

At the University of Michigan Depression Center, we offer family-centered, multidisciplinary care that is based on the results of world-class research and continual clinician education. Each child's social and developmental situation is evaluated individually, because we know that the needs of preschool children, elementary age children, young adolescents, and older adolescents are all different. We work as a team together with our patients and their families, and encourage families to ask questions and learn as much as they can about depression and bipolar illnesses.

How can a parent or concerned adult tell the difference between typical behavior and signs of depression in children and adolescents?

Children are more likely than adults to deny that they feel depressed. We don’t know whether this is because children perceive stigma more acutely or because they simply fail to recognize the symptoms of depression for what they are. Careful observation is the key to recognizing depression in young people.

Symptoms of depression vary with the developmental stage of the individual. Younger children are more likely to exhibit symptoms such as aggression, anger, or excessive crying. Among adolescents and older pre-adolescent children, symptoms may include irritability, withdrawal, loss of energy and interest in previously enjoyed activities, and changes in sleep and/or appetite. It is very common for young people of any age to show their depression through physical symptoms, such as chronic headaches or stomach aches, which cannot be attributed to other medical origins.

The only real answer is to know your child, say Depression Center experts. Only then can you distinguish between normal behavior and thoughts or actions that may be a sign of an underlying condition such as depression or bipolar disorder. For example, if your usually quiet and well-mannered 9-year-old suddenly begins behaving disruptively—or your boisterous teenager suddenly becomes silent and withdrawn—it may be time for an honest discussion and a visit with your pediatrician.

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