Persistent Depressive Disorder in Children
What is persistent depressive disorder in children?
Persistent depressive disorder is a type of depression. There are 3 main types of
Major depression (clinical depression)
Bipolar disorder (manic depression)
Persistent depressive disorder (dysthymia)
With persistent depressive disorder, a child has a low, sad, or irritable mood for
at least 1 year. They may also have major depressive episodes at times.
Depression affects a child’s body, mood, and thoughts. It can disturb eating, sleeping,
or thinking patterns. It is not the same as being unhappy or in a blue mood. It is
also not a sign of weakness. It can’t be willed or wished away. Children with depression
can’t just pull themselves together and get better. Treatment is often needed.
What causes persistent depressive disorder in a child?
This type of depression has no single cause. Many factors, such as genetics and the
environment, play a role. Depression often happens with other mental health disorders
such as substance abuse or anxiety disorders. Depression in children can be triggered
by things. These include a sudden illness, a stressful event, or a loss of someone
Which children are at risk for persistent depressive disorder?
These are the most common risk factors for depression:
Family history, especially if a parent had depression when young
Lots of stress
Abuse or neglect
Physical or emotional trauma
Other mental health problems
Loss of a parent, caregiver, or other loved one
Loss of a relationship, such as moving away or losing a boyfriend or girlfriend
Other long-term health problems, such as diabetes
Other developmental or learning problems
What are the symptoms of persistent depressive disorder in a child?
Each child’s symptoms may vary. A child must have 2 or more of the following symptoms
for at least 1 year to be diagnosed with persistent depressive disorder:
Lasting feelings of sadness
Feelings of despair, helplessness, or guilt
Feelings of not being good enough
Feelings of wanting to die
Trouble with relationships
Sleep problems, such as insomnia
Changes in appetite or weight
A drop in energy
Problems focusing or making decisions
Being grouchy, hostile, or aggressive
Suicidal thoughts or attempts
Frequent physical complaints, such as headache, stomachache, or extreme tiredness
or exhaustion (fatigue)
Running away or threats of running away from home
Loss of interest in normal activities or activities once enjoyed
Sensitivity to failure or rejection
Persistent depressive disorder symptoms may look like other mental health problems.
Take your child to their healthcare provider for a diagnosis.
How is persistent depressive disorder diagnosed in a child?
A child with this disorder may have other health problems, such as substance abuse
or an anxiety disorder. So early diagnosis of other medical and mental health problems
and treatment is important to your child getting better.
A mental health expert often diagnoses this disorder. They will do a comprehensive
mental health evaluation. They may also talk with family, teachers, and caregivers.
How is persistent depressive disorder treated in a child?
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is.
This disorder can be treated. Children may need to try different therapists and therapies
before they find what works. Treatment may include:
Medicines. Antidepressant medicines can be very helpful, especially when used with psychotherapy.
Talk therapy (psychotherapy). This treatment helps children with depression change their distorted views of themselves
and the environment around them. It also finds stressors in the child’s environment
and teaches them how to stay away from them or manage them if avoidance isn't possible.
A child also learns how to work through hard relationships.
Family therapy. Parents play a vital role in treatment.
School input. A child’s school may also be included in care.
What are possible complications of persistent depressive disorder in a child?
Persistent depressive disorder may put your child at an increased risk for major depression
if they do not get the correct treatment. It also raises the risk for your child or
teen to have other mental health disorders. And it can result in a severe reduction
in your child's long-term quality of life. Correct treatment helps to make symptoms
less severe. It also reduces the risk of having another depressive episode (called
A child with this disorder may have times of depression that last longer than 5 years.
Correct, ongoing treatment can ease symptoms and stop them from returning.
How can I help prevent persistent depressive disorder in my child?
Experts don’t know how to prevent persistent depressive disorder in a child. But spotting
it early and getting expert help for your child can help ease symptoms. It can improve
your child’s quality of life.
How can I help my child live with persistent depressive disorder?
You play a key role in your child’s treatment. Here are things you can do to help
Keep all appointments with your child’s healthcare provider.
Listen to your child. Find out about what they worry about, what they enjoy, how they
like to spend their day. Make time to be alone with your child in a nonstressful activity,
doing something they enjoy.
Look at your relationship with your child. Consider if your expectations for your
child are reasonable. A child's fear of disappointing parents can result in anxiety
and increased depressive symptoms.
Monitor your child's social media activity. Try to keep online time balanced with
exercise and time outdoors. Watch for any online bullying.
Talk with your child’s healthcare provider about other providers who will be included
in your child’s care. Your child may get care from a team that may include counselors,
therapists, social workers, psychologists, and psychiatrists. Your child’s care team
will depend on your child’s needs and how serious their depression is.
Tell others who need to know about your child’s disorder. Work with your child’s healthcare
provider and schools to create a treatment plan.
If depression significantly interferes with your child’s ability to succeed in school,
they may be eligible for specific protections and reasonable accommodations under
the Americans with Disabilities Act (ADA) or Section 504 of the Civil Rights Act.
Talk with your child’s teacher or school principal about how to get more information.
Reach out for support from local community services. Being in touch with other parents
who have a child with this disorder may be helpful.
Let your child know they can talk to you about anything, anytime. This openness is
especially important if your child starts to think about hurting themselves or attempting
When should I call my child's healthcare provider?
Call your child’s healthcare provider right away if your child:
Feels extreme depression, fear, anxiety, or anger toward themself or others
Feels out of control
Hears voices that others don’t hear
Sees things that others don’t see
Can’t sleep or eat for 3 days in a row
Shows behavior that concerns friends, family, or teachers, and others express concern
about your child’s behavior and ask you to get help
Call 911if your child has suicidal thoughts, a suicide plan, and the means to carry out the
plan. If your child has a phone, make sure they have emergency numbers in their phone.
These may include parents, other trusted adults, a healthcare provider, and the National
Suicide Prevention Hotline (800-273-8255). Help your child understand that reaching
out for help is the most important thing to do if they are thinking about self-harm.
If your child expresses suicidal thoughts, first get care right away, then make sure
all dangerous items in your home are not in reach of your child. Remove knives and
other sharp objects. Lock up guns and ammunition in separate locations. Lock up all
medicines and alcohol.
Key points about persistent depressive disorder in children
Persistent depressive disorder is a type of depression. A child with this type of
depression has a low, sad, or irritable mood for at least 1 year.
There is no single cause of this disorder. Many risk factors, such as the loss of
a loved one, can raise a child’s risk for it.
Some common symptoms are lasting feelings of sadness and sleep problems.
A mental health expert such as a psychiatrist often diagnoses this disorder after
a mental health evaluation.
Treatment includes therapy and medicine. Family therapy is also advised.
If depression greatly interferes with your child’s ability to succeed in school, they
may be eligible for reasonable accommodations under the ADA or Section 504 of the
Civil Rights Act. Talk with your child’s teacher or principal for more information.
Listen to your child and keep communication open. Let them know you want to talk to
them about anything that concerns them, especially if they ever have thoughts of self-harm.
Tips to help you get the most from a visit to your child’s healthcare provider:
Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.