More than just a condition involving sadness, childhood depression is comprised of a group of symptoms that occur at the same time. Generally, these symptoms are similar to those of depression in adults in terms of classification, such as physical, cognitive, affective, vegetative, and motivational, but with age-specific features and developmental differences.

 Symptoms

Emotional Symptoms

This condition is characterized by a sad, or dysphoric, mood. Although this is also a symptom of other childhood conditions, it is the duration and severity of this mood that classifies it as a symptom of clinical depression. It is important to note, though, that not all children suffering from this condition manifest a dysphoric mood. 

The depressed child may also experience bouts of an irritable or angry mood. This emotion has been found to be one of the most resistant to therapeutic treatment. Its severity ranges from mild feelings of annoyance to sudden outbursts of temper. As for duration, it may be fleeting or may last for several weeks. Often, an incident may trigger the mood, but if anger patterns are not discernible or if there is no association between the child's anger and environmental events, then the symptom may be more severe.

 Anhedonia, or the loss of the pleasure response, is another symptom of childhood depression. Activities that used to excite or please the child are now boring. There is an observable decrease in the number of activities that the child used to derive pleasure from as well as in the degree of pleasure. Anhedonia becomes a cause for concern if the child tends to be bored with half or more than half of his or her activities in a day.

Weepiness is also a common symptom of depression in children. Affected individuals have a lower threshold for negative environmental events, and sometimes, the child feels like crying but finds it difficult to do so. The mirth response is also reduced; a humorous situation may not evoke a smile or laughter from the child. There are also the feelings of being unloved, and of self-pity, which are revealed through one-on-one interviews with the child.

Cognitive Symptoms

The depressed child generally has a negative evaluation of self, which results in low self-esteem. This symptom should not be ignored as, researchers have found, they could lead to suicidal behavior. Another cognitive symptom of childhood depression is guilt, which surfaces after misbehavior or an incident of hurting another person. 

Hopelessness is also manifested, whereby the child feels that there is little or no possibility of a solution to his or her problems. The child's concentration also becomes affected, which means that there is a great probability of a decline in school performance. Morbid ideations are also prevalent in depressed children. And due to a combination of these cognitive symptoms, it also becomes difficult for the child to be decisive as he or she sees little hope of success in the outcome of any decision.

Motivational Symptoms

It is not unusual for a child with depression to withdraw from social activities. There is decreased interest in interacting with peers or with adults. As evident a symptom is decreased academic performance, resulting from a lack of interest in learning. School tasks become more difficult because of the onset of fatigue and apathy towards school work. 

Physical and Vegetative Symptoms

A depressed child is fatigued, or lacks the energy to pursue his or her usual daily activities. The child's rest time increases as the condition becomes more severe. Also noticeable is a decrease in the child's appetite and, consequently, in weight. However, researchers are now also looking into an increase in weight due to depression, largely due to binging, but this is still a less common symptom than weight loss in depressed children.
 
Somatic complaints, such as backaches, headaches, stomachaches, or general discomfort also become more frequent, and these may interfere with the child's activities both at home and in school. In addition, the child may experience various types of sleep disturbance such as insomnia, hypersomnia, and nonrestorative sleep, in which the child feels fatigued even as he or she has enough sleeping hours.

Diagnosis

Two Types of Childhood Depression

A child with this mood disorder may experience two types of episodes: The first is a depressive episode and the other is a manic episode. The latter is only experienced by patients with bipolar disorder or cyclothymia. The symptoms described above are typical of depressive episodes, while manic episodes are characterized by a flight of ideas and racing thoughts. The child may talk continuously and is easily distracted.

This is easily confused with attention deficit/hyperactivity disorder (ADHD), but the manic episode of childhood depression shifts to the depressive episode, while ADHD symptoms are relatively consistent. 

Years ago, researchers did not believe that children could suffer from depression. However, after hundreds of clinical trials, it has been found that childhood depression is indeed a real and serious affliction, and health professionals carefully observe the patient for the duration and severity of the symptoms.

Treatment

Treatment for childhood depression may involve psychotherapy or its combination with antidepressant drugs. Hospital care is rare; often, this condition is dealt with in an outpatient setting.

Health practitioners recommend cognitive behavioral therapy in order to focus on the child's negative perception of self. It is also advisable for family members to participate in the treatment of the child in order for him or her to be assured of support even after the treatment.

Antidepressants are recommended for patients who are found to have chronic or recurring depression and those who have bipolar disorder or psychosis. It is also ideal for those who cannot conveniently avail of regular therapy. In addition, there are symptoms which cannot be treated by therapy alone.

Antidepressant medication is given even after childhood depression symptoms are no longer observed, in order to reduce the probability of recurrence. 

Risks in Childhood Depression

A major cause for concern for this condition is the possibility of a patient bringing harm to self or others. For this reason alone, the symptoms of childhood depression should not be taken lightly and if correctly diagnosed, the condition should be treated early on.

There is, of course, a risk in taking antidepressants, but consulting a mental health professional will help both the child and his or her caregivers to be aware of any side effects. Before a child goes through a treatment regimen involving antidepressants, he or she should undergo a thorough physical and psychiatric exam. Any potential risk factors that may make it more likely for the child to engage in self-harm upon medication should also be taken into consideration.