Depression affects more than just mood: It drains energy, disrupts sleep, strips away joy, and impacts the physical body. In children, these signs present differently than in adults, and the symptoms vary significantly depending on their age

At this age, children cannot yet articulate their feelings well. Red flags include persistent withdrawal, minimal eye contact, and a lack of joy in playing. If the child also sleeps poorly, refuses food, or loses previously learned milestones, these are additional indicators. A single bad day means very little. However, if these behaviors persist for weeks, parents should take action.

Many children express their sadness through physical symptoms. They frequently complain of stomachaches or headaches with no clear medical cause. Other signs can include irritability, temper tantrums, anxious clinging, or quick exhaustion. A lack of interest in favorite toys or persistent feelings of guilt—such as "I break everything"—can also occur. When such patterns last for weeks, they must be viewed as warning signs.

A decline in school performance and a lack of energy are typical signs. If hobbies lose their appeal, sleep becomes restless, or playdates and birthday invitations are turned down, these are clear indicators. Some children appear emotionally empty, while others become restless and unfocused. School-aged children may also continue to complain of stomachaches and headaches. If the depression persists over a longer period, the risk of social withdrawal and self-deprecation increases.

At this stage, the clinical picture closely resembles depression in adults. It manifests as social withdrawal, hopelessness, severe fatigue, sleep disturbances, and a drop in academic performance. Some teenagers turn to alcohol or other substances to numb the emotional pressure. Thoughts of self-harm or suicide can emerge at this age—this constitutes an emergency. If any hints or comments are made, please seek help immediately..

There is never just a single cause; usually, several factors interact.

Body and biology

Some children have a higher natural sensitivity. Brain chemistry (neurotransmitters) and physical illnesses can also play a role. This does not mean the illness is "just in their head"—it is a real medical condition.

Thoughts and feelings

If a child frequently engages in self-deprecation—or experiences belittlement at home or school—avoids new things, and expects to fail, they are more likely to slip into a depressive mood.

Social environment

Conflicts at home, parental separation, bullying at school, financial worries, or a serious illness in the family can place a heavy burden on a child. Fleeing from war or violence and losing a loved one are also severe stressors. Reliable relationships, open conversations, and consistent daily rituals provide relief. They act like a safety net that supports the child until further help is available.

Triggers and reinforcers

A single event can set things in motion. However, depression is often maintained by a lack of positive attention, social withdrawal, and a lack of achievements. This is why behavioral activation is so crucial: small steps, noticeable successes, and praise. This is a core part of the treatment.

The guiding principle of treatment is: as much as necessary, as little as possible. It is tailored to the severity, duration, level of distress, and age of the child. The foundation always consists of a strong therapeutic relationship, psychoeducation, and a secure daily routine built on sleep, physical activity, and a structured day.

For mild cases, counseling and guided exercises are often sufficient. For moderate and severe cases, the child will need psychotherapy. In severe situations, medication can provide additional support.

• Cognitive Behavioral Therapy (CBT): It helps identify and change unhelpful thought patterns. Step by step, it increases behavioral activation and joy. Parents are actively involved. It is highly effective for mild, moderate, and severe depression.
• Interpersonal and relationship-focused therapy: This approach looks closely at stress within friendships, family, and school. The goal is to resolve conflicts and strengthen support systems. It is well-suited for distinct social or interpersonal difficulties.
• Family therapy and support: Parents and siblings learn to recognize symptoms, de-escalate sensitive topics, and establish a reliable daily routine. This significantly enhances the effectiveness of the individual therapy.
• Medication: If the depression is severe or therapy alone is not enough, an antidepressant can help. Only selected medications are considered, under close medical monitoring. Initiating and managing this treatment belongs in the hands of an experienced child and adolescent psychiatrist or pediatrician. Informing families about the benefits and risks is mandatory. For teenagers aged 12 and older, Fluoxetine is often considered in addition to psychotherapy. For children aged 5 to 11, psychotherapy is always the first line of treatment. Medication is only chosen if the child continues to experience severe distress despite therapy. For children under 8, there are no approved antidepressants for depression—here, psychotherapy is the absolute standard.

• Strengthen daily structure: Establish consistent times for sleep, school, meals, physical activity, and relaxation. It is better to have a few fixed routines than many loose resolutions. Physical activity is proven to help.
• Behavioral activation in small steps: Plan together what might feel good today. Five minutes at the beginning is enough. Do not pressure your child, but accompany them—this takes away the power of social withdrawal. Most importantly: notice and celebrate small achievements to reinforce positive experiences.
• Manage screen time wisely: Set fixed times and stick to them. Keep smartphones, tablets, and gaming consoles out of the bedroom. A calm evening routine without screens helps the mind unwind. Good sleep nourishes the soul and builds strength for the next day.
• Involve the school: Inform your child’s teacher and the school social work team. Agreements regarding assignments, breaks, and academic workload help prevent relapses.

Seek professional guidance: Your pediatrician is always the first point of contact for professional help. They will rule out physical causes, offer guidance, and provide referrals to specialists. However, there are additional resources available.

You do not have to go down this path alone. The following services are here to help:

• Pediatric clinics and practices: Your first point of contact for initial assessments, referrals, medical leave certificates (sick notes) if needed, and connections to local support networks.
• Child and adolescent psychotherapy practices: Outpatient care focusing on diagnostic assessments, specialized treatment (usually CBT), family support, and crisis management plans.
• Child and adolescent psychiatric hospitals: If the depression is severe, they provide comprehensive care through day-clinic (partial hospitalization) or inpatient programs.
• Crisis support: For immediate emergencies, call 112. For free and anonymous support, contact the youth helpline "Kinder- und Jugendtelefon" at 116111 or the "TelefonSeelsorge" crisis hotline at 0800 1110111.

Use pictures and simple words. "Your stomach hurts often. That is a sign that your feelings are heavy right now. We are going to get help." Repeat these core messages, as rituals provide a sense of security. In addition, ensure consistent sleep and meal times, keep transitions short, and spend plenty of time outdoors.

Identify and name feelings together with your child. For example, you can use a feelings journal with three columns: "This is the situation," "This is my thought," and "This is my feeling." Brainstorm small daily challenges to build courage and plan rewarding breaks. This creates connection, fosters accomplishments, and sparks joy.

At this stage, it is crucial to first acknowledge your child's desire for independence. Ask without placing pressure on them: "What is making things difficult right now?" and also, "What has made you feel good recently?" Maintain your connection and talk together about sleep, school, hanging out with friends, and social media.

Digital Health Applications (in German DiGA) are certified, prescription-based apps or online programs. In cases of depression, they can provide immediate support, effectively bridge the waiting period for a therapy placement, or serve as a valuable complement to ongoing treatment. As a rule, health insurance funds cover the full cost of these applications, provided they are officially listed in the DiGA registry. You can access them either via a direct prescription from your doctor or therapist, or under certain conditions, directly through your health insurance provider.

deprexis is an innovative, evidence-based, and globally established digital therapy for adults experiencing mild, moderate, or severe depressive episodes. The core goal of this treatment is to achieve a sustainable improvement in depressive symptoms and to help safely increase your daily activity levels.