What are the symptoms? The symptoms of depression in children and young people include changes in mood, thinking and behaviour. The key symptoms are: persistent sadness or low (irritable) moodloss of interests and/or pleasurefatigue or low energy levels. These core symptoms may also be accompanied by: change in sleeping patterns – poor or increased sleepagitation or slowing of movementchange in eating habits – poor or increased appetitelow self-confidence and indecisivenessfeelings of guilt, self-blame or worthlessnesslack of concentration leading to lower school performanceself-harm and possible suicidal feelingswithdrawal from communication with other children and young people. What are the causes? Depression usually has multiple causes. Commonly, a child or young person who is more vulnerable to depression because of genetic and biological factors, and early adverse experiences, will have their depression ‘triggered’ by an adverse life event against a backdrop of more chronic social or psychological difficulties. This can help explain why when more than one child experiences a similar adverse event or lives in similar psychosocial circumstances, not all will develop depression. Possible biological factors include changes in monoamine transmitter levels (a special type of chemical in the brain), and also changes in cortisol metabolism. Common psychosocial difficulties include, for example, family disharmony, divorce, separation, domestic violence, child abuse, and school difficulties such as bullying, academic problems and/or isolation. Typical triggers include life events such as the breakdown of an important relationship or bereavement. How is it diagnosed? A diagnosis will usually be made after a healthcare professional talks with the child or teenager both with and without his/her parents. Information from others such as a teacher who knows the child or teenager may be sought. Occasionally, a physical condition can lead to symptoms similar to those of depression. For this reason, a physical examination may be needed to eliminate conditions such as glandular fever, anaemia, breathing problems such as sleep apnoea or thyroid disorders. If a diagnosis of depression is made, it may be described as mild, moderate or severe according to the number of symptoms that are identified. How is it treated? Treatment of depression in children and young people falls into two categories: psychological treatments (psychotherapy or counselling – talking treatments); and physical treatments (medication). Psychological treatments should be suggested first. For mild depression, referral to a specialist may not be necessary and the healthcare professional may advise ‘watchful waiting’ – monitoring the progress of the young person accompanied by sensible advice about diet, exercise and encouraging the child to take part in normal activities. If there is no progress or if the depression is more severe, psychological treatments such as cognitive behaviour therapy and interpersonal therapy will be suggested. Other psychological treatments that may be suggested include family therapy and more intensive individual child psychotherapies. If psychological treatments are not bringing about improvement, or if the depression is more severe, then, in teenagers, antidepressant medication will be suggested (and considered even in children) in addition to the psychological treatment. Where medication is prescribed, children and young people should be monitored carefully in the first few weeks for adverse effects. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines on the treatment of depression in children and young people for healthcare professionals, children and young people themselves, parents and carers (see the NICE website). Inheritance patterns and prenatal diagnosis Inheritance patternsNone. Prenatal diagnosisNone. Is there support? Information and support in the UK for depression in children and young people is provided by Young Minds and the Scottish Mental Health Association (see entry Mental Health).