Is my child depressed or just sad?

Aria, a 10-year-old from Renton, Washington, has struggled with volatile emotions since she was very young. When Aria was 5, her mother, Kristie, was hospitalized for a week and the separation affected Aria deeply.

“She was angry all the time and had a hair-trigger reaction over everything,” said Kristie. (Only first names are used in this article to maintain the family’s privacy.) “Little things would set her off. She had hour-long screaming fits, and she’d break things in her room, and hit people and try to hurt them.”

Aria’s parents found a therapist through Kaiser Permanente who helped her understand and work with her feelings. Ashok Shimoji-Krishnan, MD, MPH, a child and adolescent psychiatrist with Kaiser Permanente in Seattle, later joined Aria’s mental health care team, and she continued to improve dramatically with a combination of therapy, medication, and parental support.

Then the COVID-19 pandemic hit, and Aria’s school closed down. Around the same time, her therapist transferred to a different role, and her best friend moved away.

Aria struggled with these disruptions to her routines and the loss of crucial sources of structure and connection. She refused to get out of bed, and when she did, she would often spend the whole day in the recliner in the living room. She refused to eat, didn’t want to go on walks around the neighborhood, and stopped interacting with her parents and friends.

“It was just horrible to see,” Kristie said. “It was like her candle went out.”

Depression in children and adolescents

In Aria’s case, it was clear to her parents that something serious was wrong, but it isn’t always easy to determine whether a child is experiencing depression or just going through a rough patch and will bounce back on their own.

“We expect kids to be moody sometimes,” said Dr. Shimoji-Krishnan. “We get concerned when moodiness becomes a chronic pattern and they’re withdrawn or irritable most of the time.”

Pulling away from parents is a normal part of growing up. But when kids stop wanting to spend time with any of their friends or lose interest in activities they’ve enjoyed, it may be a sign they’re becoming depressed and need help with their mental health.

“Social withdrawal is unusual for most adolescents,” said Dr. Shimoji-Krishnan. “Young people tend to gravitate toward their friends, so when they withdraw from them it is concerning.”

When to get help

Adolescents who suffer from depression have a higher risk of misusing substances and engaging in other risky behaviors. They can be impulsive and often don’t take the big picture into account, so depression raises the risk of self-harm and suicide.

If you think your child may be contemplating self-harm, don’t be afraid to start a conversation. You can ask, “Have you been thinking about suicide?”

“Talking about suicide doesn’t encourage a young person to act on those feelings,” Dr. Shimoji-Krishnan explained. “If anything, talking about the subject actually reduces the stigma around those feelings and shows that it’s safe to express those thoughts and get help.”

If you are worried, trust your gut and ask for help. Addressing mental health challenges in young people lowers the risk that the conditions will linger and become more serious in later adolescence and adulthood. It also decreases the risk of suicide, substance misuse, and other issues.

‘She doesn’t have to carry depression into adulthood’

As the pandemic stretched on, Aria continued to struggle with depression, and Kristie was determined to continue supporting her daughter’s mental health. While it took a while to find another therapist Aria connected with, they found one whose office was just 10 minutes away from their home.

“We knew we finally had our kid back on the first day of school this year,” Kristie said. “After not being herself over the last 18 months, being able to interact with other kids helped build up her sense of self again.”

Aria is now channeling her big emotions into theater, and she recently auditioned for a role in the school play.

“She doesn’t have to carry that anger, anxiety, and depression with her into her teen years and adulthood,” Kristie said. “The care we’ve gotten has just been amazing. Bless Dr. K’s heart for giving us the support we’ve needed the whole way through.”

Learn more about mental health care at Kaiser Permanente.