Depression in Children and Adolescents vs. Adults: Recognizing the Differences

Depression is one of the most common psychiatric disorders, affecting millions of people worldwide. Unfortunately, children and adolescents are not spared when it comes to mental illness, as evidenced by ever increasing rates of pediatric and adolescent depressive disorders. According to a report from the National Survey on Drug Use and Health (NSDUH), rates of depression in U.S. adolescents increased from 8.1% in 2009 to almost 15.8% in 2019 (Wilson & Dumornay, 2022).

Despite its prevalence, depression in younger populations often goes unrecognized because it can present differently than depression in adults. When we think of classic depression, we often picture symptoms such as persistent low mood, loss of interest in previously enjoyable activities (anhedonia), and feelings of worthlessness. While these symptoms can occur in children and adolescents, depression may present differently in these groups, making it essential for mental health clinicians, parents, and even teachers to be aware of these discrepancies.

How Depression Presents Differently in Children and Adolescents

Children:

Younger children with depression may not express sadness in the same way adults do. Instead, they might exhibit increased irritability, excessive clinginess, frequent crying, poor concentration, or unexplained physical complaints such as headaches or stomachaches (Bhatia & Bhatia, 2007). Some children may become more withdrawn, while others display oppositional or defiant behaviors that may be misinterpreted as discipline issues rather than signs of distress. Academic challenges may emerge due to difficulty concentrating and low motivation (Lundy et al., 2010).

Adolescents:

In teenagers, neurovegetative symptoms including poor energy, appetite and weight changes, and insomnia are more common than in their adult counterparts (Rice et al., 2019). Adolescents struggling with depression may also exhibit heightened irritability, mood swings, or unexplained anger rather than classic sadness (Balzer, 2019). Social withdrawal is common, but rather than isolating completely, some teens may continue engaging with close friends while distancing themselves from family. Additionally, some research indicates an association between sensitivity to rejection and depression in adolescents (Marston et al., 2011). Finally, along with depressive symptoms, non-suicidal self-injury (NSSI) including self cutting or burning and suicidal thoughts and behaviors often surface in adolescence, making early detection and intervention crucial (Başgöze et al., 2021).

Assessment and Diagnosis: A Functional Psychiatry Perspective

Because depression symptoms can look different at various ages, assessment must be developmentally appropriate and consider root causes beyond just symptom checklists and self-report questionnaires. In younger children, play-based evaluation or indirect questioning (e.g., “What makes other kids feel sad?”) can provide insight into their emotions when they struggle to verbalize them. Adolescents may benefit from a mix of self-report questionnaires and open-ended discussions, allowing them to express themselves in a setting that feels safe and nonjudgmental.

Modifying the assessment process is essential, as undiagnosed and untreated depression in children and adolescents can have life-threatening consequences. Several lines of research have elucidated the long-term consequences of untreated pediatric and adolescent depression. One study found that depression in childhood and/or adolescence was associated with higher rates of adult anxiety and substance use disorders as well as worse overall health and criminal and social functioning (Copeland et al., 2020). A more encouraging insight from the same study was that engagement in mental health care was protective against the aforementioned poor outcomes.

From a functional psychiatry perspective, evaluating underlying contributors such as nutritional deficiencies, gut dysbiosis, metabolic dysfunction, and chronic inflammation can be just as important as psychological assessment.

Tailoring Treatment for Depression to Developmental and Biological Needs

While treatment strategies for depression share core elements across all age groups, the approach must be individualized, addressing not only symptoms but also biological and environmental drivers.

• Psychotherapy: In children, behavioral and play therapies may be more effective than traditional talk therapy (Gupta et al., 2023). Adolescents may benefit from cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) (Clark et al., 2012).
• Lifestyle and Functional Medicine Approaches to Depression:
  • Nutrition: Deficiencies in omega-3 fatty acids, vitamin D, B vitamins, and minerals such as zinc and magnesium can contribute to depressive symptoms. Identifying and correcting these imbalances can be a crucial part of treatment.
  • Gut Health: The gut-brain connection plays a significant role in mood regulation. Dysbiosis, intestinal permeability, and food sensitivities (such as gluten intolerance) may exacerbate symptoms in some children and adolescents.
  • Metabolic Health: Blood sugar dysregulation and insulin resistance can contribute to mood instability and energy fluctuations.
  • Sleep and Circadian Rhythm: Supporting sleep hygiene and circadian rhythm regulation through light exposure, movement, and stress management is essential for improving mood stability.
• Medication Considerations: While SSRIs may be considered for moderate to severe depression, careful monitoring is necessary in younger populations due to potential side effects, including increased suicidality (Li et al., 2022). Using medication as part of a broader, individualized treatment plan that incorporates therapy, metabolic, and nutritional interventions to optimize response and minimize side effects is typically the best approach.

Conclusion

Recognizing the developmental differences in depression is critical for early intervention and effective treatment. Children may not have the language to describe their emotions, and adolescents may externalize their distress in ways that are mistaken for behavioral problems. A functional psychiatry approach considers psychological, biological, and environmental influences, ensuring young patients receive comprehensive care that addresses root causes rather than just symptoms. By integrating evidence-based lifestyle, nutritional, and metabolic interventions alongside traditional therapies, providers can create a more effective and personalized treatment approach for children and adolescents struggling with depression.