Psychiatrists, other mental health professionals, pediatricians and educators are increasingly identifying the problem of depression among children and adolescents. Though major depressive disorder in preschool-age is rare and is estimated to about 0.3% but the prevalence rate increases with age. Among school-age children, about 2% have major depression and the rate increases to 5% among adolescents. The rates are much higher in a clinical setting. Up to 10% of children and 20% of hospitalized adolescents suffer from depression. Suicide is a known complication of depression, and it is the fourth leading cause of death in children between the ages of 10 and 15 years and the third leading cause of death among adolescents. Early recognition and treatment at pediatricians level is of paramount importance as depressive disorders are known to recur and, if not treated successfully, produce considerable short term and long term difficulties in the form of poor academic achievement, delayed psychosocial development, substance abuse and even suicide.

Unlike their adult counterparts, children are not able to communicate about sadness of mood, or loss of interest or pleasure, the core symptoms of depression. Developmental level of the child appears to influence the expression of these mood symptoms. Among preschool children these symptoms of depression are evidenced by a lack of smiling, apathy toward play, and significant loss of involvement in all other activities. These children may become tearful or irritable easily.
Among school-aged children, deteriorating school performance and avoidance of peers may signal depression. Increased irritability, fighting, argumentativeness or school refusal may be associated features of a major depression in a child of this age. They may engage in activities that may be destructive toward themselves, others, and property. Physical complaints like stomachache or headache are not uncommon in this age group. Symptoms of depression such as guilt, hopelessness, and negative beliefs about their future are more likely to be experienced by depressed adolescents rather than younger children. Unlike adult depression, there is hardly any sleep or appetite disturbance in childhood depression. However, failure to attain expected weight gain should alert the clinician to evaluate for chronic form of depression. While suicidal thoughts occur with equal frequency at all ages, the completed suicide is rare among children suffering from depression as they have limited ability to plan and carry out a lethal attempt.
Other symptoms that may call for evaluation of depression among children are: poor self-esteem, poor concentration, withdrawal from social activities, social phobia, hypersomnia, negativistic or frankly antisocial behaviour, and alcohol or substance abuse and death wishes.
The depression among children causes clinically significant impairment in social, academic and other important areas of functioning. The school performance, behaviour, peer relationship and family relationship, all are affected.
The presence of major depression in a child or adolescent increases the risk of an additional psychiatric diagnosis ten- to twenty fold. The main psychiatric disorders that major depression must be distinguished from include anxiety disorders, conduct disorders, attention-deficit/hyperactivity disorder and substance use disorders. Quite often these psychiatric conditions coexist with depression.
The depression in children and adolescent is treatable. Both Psychotherapy as well as pharmacotherapy are known to be effective in treating children with depression. It is necessary to assess the family environment, because depressed preschoolers are at high risk for having been victims of some form of maltreatment. Family members must be educated about the illness, its outcome and the available treatment forms. They should know that child might require long-term social skills training to prevent recurrences.
The use antidepressant medication requires a thorough baseline physical examination. A base line ECG is also required. Though antidepressants have yet to receive Food and Drug Administration (FDA) approval. However, antidepressants like fluoxetine, imipramine and clomipramine have been used with success.

The course and prognosis of depression depends on age of onset. Early the onset of age, worse the prognosis. Hence it is more likely that major depression among children predicts a serious, relapsing disorder with lingering social impairment and a high risk of suicide.