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 depression:

• 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. He or she 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 important.

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

• Cigarette smoking

• 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

• Low self-esteem

• 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 (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. Have your child see his or her 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. He or she will do a comprehensive mental health evaluation. He or she 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 him or her how to stay away from them. 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 he or she does 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 relapse).

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 your child:

• Keep all appointments with your child’s healthcare provider.

• 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 his or her depression is.

• Tell others 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, he or she 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.

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 himself or herself 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 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.

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.

• If depression greatly interferes with your child’s ability to succeed in school, he or she 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.

Next steps

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.