Recognizing Depression in Children and Adolescents

Julia Ebhardt: Yes, we’re seeing both: On the one hand, people are talking more openly about mental health issues today. As a result, parents and teens are more likely to seek help than they used to be. On the other hand, studies show that mental health challenges have actually increased since the COVID-19 pandemic began. This, by the way, is a global trend. In particular, symptoms of depression, anxiety, and eating disorders are occurring more frequently than they did a few years ago. Even after the pandemic ended, the numbers have not returned to their previous levels.

However, there isn’t just a single reason for this. Societal crises, pressure to perform, stress, social media, and personal predispositions often interact. The development of mental illness is always the result of a combination of many factors.

A bad day or a bad week isn't necessarily a cause for concern. The key factor is whether a child changes significantly over several weeks and whether these changes noticeably interfere with daily life.

Many parents know their child very well. If they notice, “This behavior doesn’t fit my child at all, or my child has changed so much”—then they should take notice.

At first, many people think their child simply doesn’t feel like doing something or lacks motivation. But that’s often a misconception. Teens with depression often don’t “want to” do things—they simply can’t. A typical feature of the condition is that it feels as if a heavy veil has been cast over everything. Even small tasks suddenly seem overwhelming. When parents then say, “Why don’t you just unload the dishwasher?” or “Why don’t you go out and see your friends?” it can feel like an insurmountable mountain to the child affected.

Parents should be especially vigilant if their child

• becomes increasingly withdrawn, 
• neglects friendships,  
• gives up hobbies for no reason, 
• sleeps poorly, 
• barely has an appetite, 
• can’t concentrate in school, 
• suddenly gets significantly worse grades, or
• seems hopeless. 

Sometimes changes are also evident in the fact that the child can no longer manage everyday tasks: The child no longer responds to WhatsApp messages, cancels plans, doesn’t shower for days, or wears the same T-shirt over and over again because they’ve become indifferent to everything.

Yes, you could say that. The symptoms also depend on age. Younger children, for example, cry more often, withdraw, or have a hard time making friends. With boys, we often see more irritability, frustration, or anger.

Teenagers, on the other hand, often lose interest in things that used to be important to them. They hardly ever meet up with friends, give up their hobbies, or withdraw completely into their rooms.

It helps to voice specific observations. For example: “I’ve noticed that you’ve hardly been seeing your friends lately. I’ve seen that you’ve canceled practice several times. I’m worried about you. Is there something weighing on your mind? Is there anything I can do to help?”

This makes a child feel much less pressured than statements like, “I think you’re depressed.” Parents don’t need to make a diagnosis.

This actually happens quite often. Many teenagers don’t even understand what’s going on with them. Some don’t want to put an extra burden on their parents or believe they have to solve the problem on their own. In these cases, one thing helps above all else: patience.

Parents can say, “It’s okay if you don’t want to talk about it today. I’ll ask you again in a few days.” It’s important to stay on top of it and not let the topic drop again.

Parents can also seek support for themselves if, for example, their child refuses any help. Parenting and family counseling centers are the right places to turn to in such cases. The trained professionals there can work with the parents to figure out how to have successful conversations.

Often, teenagers will first open up to friends or school social workers. That, too, can be a first step.

Above all, pressure or threats are unhelpful. Phrases like “Pull yourself together,” “If this doesn’t get better, then…” or “You just need to get out of the house again” usually don’t help.

A calm, supportive attitude is better. But: Parents don’t have to find the perfect words. What matters most is that the child feels: “I’m not alone.”

As a general rule, we say, “Better once too soon than once too late.” If a child’s mood deteriorates significantly over at least two weeks and they are having difficulty coping with daily life, parents should seek medical advice. The earlier depression is treated, the better the chances of a successful outcome.

The first point of contact in the event of depression or suspected depression is a pediatrician’s office or a family doctor’s office. From there, the next steps can be taken.

The waiting period can be stressful and should not be allowed to pass without being put to good use. Parenting and family counseling centers, school social work programs, and reputable online resources such as FIDEO can offer families guidance, relief, and initial support even during this time.

If a child expresses specific thoughts of suicide, writes a suicide note, or seriously harms themselves, parents must act immediately. They should drive to the nearest hospital right away or call 112. It’s also important to remember: During an acute crisis, parents must never leave their child alone.

No, there are always many factors at play. Depression develops in individuals with a predisposition that stems from genetics or early trauma. Triggers for the condition can include ongoing conflicts, chronic stress, life events such as a change in schools, or hormonal changes like the onset of puberty. The condition can affect anyone.

What’s far more important is something else: that parents pay attention, take changes seriously, and seek help. That is precisely their most important task.

Depression is a condition that can be effectively treated in children and adolescents. The earlier a condition is recognized, the better the chances of successful treatment. My appeal to parents is therefore: “Don’t wait for months, hoping it will go away on its own. It’s better to ask for help once too often than once too little.”

It’s also important to me to emphasize: Depression is not a character flaw, and parents are not automatically to blame for the condition. It is, after all, a serious illness that arises from the interplay of many different factors. Seeking help early creates the best conditions for children and adolescents to recover. Parents and children don’t have to go through this alone. There are many people and organizations that support families.