Mood Disorders in Children: Types, Signs and Diagnosis

What are mood disorders in children?

Mood disorders are mental health conditions in which a child’s mood, whether low, irritable or abnormally high, changes in a way that is more intense or lasts longer than ordinary ups and downs, and gets in the way of daily life.⁠^1,2 They are among the mental disorders that can begin in childhood.⁠⁵

The DSM-5 no longer uses “mood disorders” as a single chapter: it splits them into depressive disorders and bipolar and related disorders.⁠⁷ The depressive disorders include major depression, persistent depressive disorder, disruptive mood dysregulation disorder (DMDD) and premenstrual dysphoric disorder; the bipolar group includes bipolar I, bipolar II and cyclothymic disorder.⁠^3,4

How is a mood disorder different from normal sadness or moodiness?

By how long it lasts, how often it shows up and how much it disrupts. All children are sad, irritable or angry at times, and occasional sadness is a normal part of growing up.⁠^5,13

Depression is different: the sadness and related symptoms are more intense or last longer than usual, they can come without any triggering event, and a child may have depression if the symptoms occur every day for more than two weeks.⁠¹ Grief after a loss is normal and usually eases with time, though grief and depression can occur together.⁠^1,3

Bipolar disorder is not the typical ups and downs every child goes through: its mood changes are more extreme, often unprovoked, and come with changes in sleep, energy and thinking.⁠²

What are the types of mood disorders in children?

The main types seen in children and teens are major depressive disorder, persistent depressive disorder, DMDD and bipolar disorder; premenstrual dysphoric disorder can begin once periods start.⁠^3,4,14

A diagnosis is not given when the symptoms are caused by a substance, a medication’s side effects or a medical condition such as an underactive thyroid.⁠⁷

What is major depressive disorder in children?

Major depressive disorder, or depression, means at least two weeks of a depressed mood or lost interest, most of the day, nearly every day, along with four or more other symptoms, such as changes in sleep or appetite, fatigue, worthlessness or guilt, poor concentration, or thoughts of death.⁠⁷

In children and teens the mood can be irritable rather than sad, and a child may fail to make expected weight gains rather than lose weight.⁠⁷ Childhood depression covers it in full.

What is persistent depressive disorder (dysthymia)?

Persistent depressive disorder, once called dysthymia, is a long-lasting low or irritable mood: in children and teens it must last at least a year, rather than the two years required for adults.⁠^3,7 It is usually less severe than major depression, though a child can have both at once.⁠^1,7 See persistent depressive disorder.

What is disruptive mood dysregulation disorder (DMDD)?

DMDD is a childhood mood disorder of chronic irritability and anger with frequent, intense temper outbursts, without the distinct episodes of bipolar disorder.⁠^3,15 It is diagnosed from age 6 to 18, when symptoms began before 10 and have lasted at least a year in at least two settings, and applies to roughly 1% of school-age children.⁠^3,7 See DMDD.

What is bipolar disorder in children?

Bipolar disorder causes episodes of mania or hypomania, an abnormally high, expansive or irritable mood with increased energy, usually alongside episodes of depression.⁠^4,7,16 The episodes are a noticeable change from the child’s usual self, and they often last days or weeks.⁠^2,7

Children and teens are more likely than adults to have mood swings even within an episode, which is one reason the diagnosis is hard to make.⁠¹⁷ See bipolar disorder in children and teens.

What is premenstrual dysphoric disorder (PMDD)?

PMDD is a severe form of premenstrual mood change, added to the DSM-5 in 2013: severe depression, irritability or anxiety in the week or two before a period that usually goes away two to three days after it starts.⁠^3,14 Diagnosis rests on a symptom calendar or diary kept over time.⁠¹⁴

How common are mood disorders in children and teens?

Uncommon in young children and much more common in teens. In US national data from 2016 to 2019, 0.1% of children aged 3 to 5 had ever been diagnosed with depression, 2.3% of those aged 6 to 11, and 8.6% of those aged 12 to 17.⁠⁸

The AAP estimates that 2% to 3% of children aged 3 to 11 have depression, that as many as 1 in 5 adolescents have depression at some point in their teens, and that 1% to 2% of US children under 18 live with bipolar disorder.⁠^1,17 Figures differ because studies use different measures and diagnostic criteria.⁠^8,20

Girls are affected more often from adolescence: in 2021 nearly three in ten teen girls had a major depressive episode, and in a 20-year study of the children of depressed and non-depressed parents, new cases of major depression peaked between ages 15 and 20, mostly in girls.⁠^18,22

What are the signs of a mood disorder in a child?

The signs that matter most are changes from your child’s usual self that last: a low or irritable mood most of the day, lost interest in things they enjoyed, and changes in sleep, eating, energy or schoolwork.⁠^1,13 Any of these can happen in a child who is not depressed; seen together, nearly every day, they are red flags.⁠¹

• Irritability, not just sadness

  Seeming more sad and irritable than usual, in a low mood most of the day; in children an irritable mood can count toward depression.⁠^1,7

• Losing interest

  No longer enjoying activities that used to make them happy, one of the two most common signs of depression.⁠¹

• Changes in sleep, appetite or energy

  Sleeping much more or less, a marked change in eating or weight, or less energy for even simple tasks.⁠¹

• Aches and pains

  Frequent headaches or stomachaches, which children may have in place of describing sad feelings.⁠^1,13

• Pulling away

  Spending more time alone and less with friends, and caring less about activities and school.⁠^1,13

• Slipping at school

  Struggling or failing at school, or trouble concentrating and making choices.⁠^1,23

• Unusual highs

  Intense happiness or silliness for long periods, little sleep without feeling tired, and risky or reckless behavior, which can signal a manic episode.⁠²

• Talk of death or suicide

  Talking about wanting to die, or about being a burden; take it seriously and get help immediately.⁠^5,24

How do mood disorders look different in children than in adults?

Children often show irritability more than sadness, and the diagnostic criteria allow for it: in children and teens an irritable mood can count toward major depression and persistent depressive disorder.⁠^1,7 Depressed children may complain of headaches or stomachaches, and may not know how to describe what they feel.⁠^1,13

Persistent depressive disorder needs one year of symptoms in a child, not two, and a child may fail to gain weight as expected rather than lose weight.⁠⁷ Depressed teens may also use alcohol or drugs to try to feel better.⁠¹³

What are the warning signs of suicide in children and teens?

NIMH lists talking about wanting to die, great guilt or shame, or being a burden; feeling empty, hopeless or trapped; and changes such as making a plan, withdrawing, giving away belongings, extreme mood swings, or using drugs or alcohol more often. Get help as soon as possible, especially if the behavior is new or has increased.⁠²⁴

These signs matter: suicide is the second-leading cause of death among young people aged 10 to 19, and NIH researchers found that preteen suicide rates (ages 8 to 12) have risen by about 8% a year since 2008.⁠^12,25 If you are worried now, use the crisis lines at the top of this page.

When should you talk to a doctor about your child’s mood?

If you notice signs of depression for more than two weeks, talk with your child’s doctor.⁠¹ NIMH also suggests seeking help when behavior or emotions last for weeks or longer, cause distress for your child or family, or interfere with school, home or friendships.⁠⁵

If your child becomes moody and withdrawn, or seems unusually high for days, ask your child how they are feeling and call their doctor; if your child talks about hurting themselves or someone else, seek help immediately.⁠^2,5,13

Episodic or chronic: how do doctors tell bipolar disorder from DMDD and depression?

By the pattern over time. Bipolar disorder comes in distinct episodes that are a clear change from the child’s usual behavior; DMDD is chronic irritability that is the child’s usual state; depression is a period of low or irritable mood and lost interest.⁠^4,7,15

Families differ too: youths with severe, non-episodic irritability have lower family rates of bipolar disorder than youths with bipolar disorder.⁠⁹ If bipolar disorder is raised, it is fair to ask what distinct episodes have been seen, how long they lasted and how they differed from your child’s usual self, since those are the features the diagnosis turns on.⁠^2,4

Why were so many children once diagnosed with bipolar disorder?

Diagnoses of bipolar disorder in young people rose sharply in the 1990s and early 2000s: US office visits by young people with a bipolar diagnosis rose from 25 to 1,003 per 100,000 between 1994–1995 and 2002–2003.⁠¹⁰ DMDD was added to the DSM-5 in 2013 to address concerns that chronically irritable children were being overdiagnosed with bipolar disorder.⁠¹¹

Bipolar diagnoses did fall, but probably not because of DMDD. A 2026 analysis of health records from 2003 to 2025, covering ages 6 to 18, found that DMDD diagnoses rose after its introduction while bipolar diagnoses declined, yet the turning point for bipolar diagnoses came in 2009, several years before DMDD existed.⁠¹¹

The authors conclude that the decline most likely reflects mounting evidence against broad bipolar diagnoses in chronically irritable children, rather than a direct effect of DMDD, and that prescribing of antipsychotics and mood stabilizers did not change at once. They add that such trends should be read with caution while the categories themselves remain uncertain.⁠¹¹

Can toddlers or young children have bipolar disorder?

Bipolar disorder can begin in childhood, but most people are diagnosed in adolescence or adulthood.⁠² Big feelings are normal in toddlers: tantrums are part of development and happen most between ages 1 and 3, then tend to get better.⁠²⁶

Because the diagnosis in children is complex, AACAP says it involves careful observation over an extended period, and rates of pediatric bipolar disorder have not been rising over time.⁠^16,20 If a young child’s moods are extreme, last for days, or come with little sleep and no tiredness, ask their pediatrician for an evaluation.⁠^2,25

What causes mood disorders in children?

No single cause. Genetic, biological, environmental and psychological factors all play a part in depression, and the exact causes of bipolar disorder are unknown, with several factors contributing.⁠^2,27

• Family history

  Depression and bipolar disorder run in families: in a 20-year study, children of depressed parents had about three times the risk of major depression.⁠^2,13,22

• Stress, loss and trauma

  Stress, losing someone close, abuse or neglect, bullying and other adverse events raise the risk.⁠^12,13

• Brain and biology

  Differences in brain structure and function have been found in bipolar disorder, and biological factors play a role in depression.⁠^2,27

• Other conditions

  Attention problems, learning issues, conduct or anxiety disorders raise the risk of depression, and autistic people are about four times as likely to have depression in their lifetime.⁠^13,28

Sometimes depression seems to come out of nowhere; other times it follows stress or the loss of someone close.⁠¹³ Bullying and spending a lot of time on social media may be associated with depression.⁠¹³

Are mood disorders genetic?

Partly. If one identical twin has depression, the other has about a 70% chance of having it at some point in life, and a close family member with bipolar disorder raises a child’s chances.⁠^2,3

Genes are not destiny: having a family member with bipolar disorder does not mean other family members will have it, and people with a genetic risk may be more likely to develop it after trauma or other stressful events.⁠²

What else can look like a mood disorder in a child?

Several things, which is why a medical check is part of the evaluation. A physical examination should look for medical conditions that can mimic depression, such as hormonal imbalances, vitamin deficiencies, neurological problems, and drug or alcohol use.⁠³

• Medical conditions. An underactive thyroid can cause depressive symptoms, and outbursts can occur with epilepsy or hormone problems such as diabetes or thyroid issues.⁠^7,29
• Medications and substances. A diagnosis is not made when a substance or a medication’s side effects explain the symptoms.⁠⁷
• Grief. Sadness after a loss is normal and should not be confused with depression, though the two can coexist.⁠^3,7
• Other childhood conditions. ADHD, conduct problems, oppositional defiant disorder, anxiety disorders and DMDD can all share symptoms with bipolar disorder.⁠^2,17

Can ADHD, autism or sensory problems look like a mood disorder?

They can overlap with one, and they can also occur alongside one. NIMH notes that bipolar symptoms may overlap with ADHD, conduct problems, major depression and anxiety, and AACAP lists attention problems and learning issues among conditions that raise the risk of depression.⁠^2,13 See ADHD.

Autistic children can have outbursts when routines change, when they are overwhelmed by loud noises or bright lights, or when they do not understand what is said to them, which can look like a mood problem.⁠²⁹ Depression is also more common in autism: a meta-analysis of 66 studies found autistic people about four times as likely to have depression in their lifetime.⁠²⁸ See autism and sensory over-responsivity, which explains how sensory overload differs from anxiety.

How are mood disorders diagnosed in children?

Through a careful evaluation by a professional, not a single test: there are no blood tests or brain scans that can diagnose bipolar disorder, and depression is diagnosed from symptoms that last and change daily functioning.⁠^2,3

1. Start with your child’s doctor. Describe what you and your child’s teachers have seen; the doctor can refer you to a mental health professional experienced with children.⁠⁵
2. Screening questions. From age 12, many doctors use a brief depression questionnaire every year.⁠^1,12,30
3. A full evaluation. A parent interview on development, temperament, relationships, health and past treatment, information from school, and, if needed, an interview with the child.⁠⁵
4. A medical check. A physical exam and, where needed, tests to rule out conditions that can mimic a mood disorder.⁠^2,3
5. Mood over time. Patterns of mood, sleep and energy, sometimes tracked on a mood chart, especially when bipolar disorder is a question.⁠^2,16

Clinicians use reliable rating scales and interviews with the young person and caregivers, checked against the DSM-5 criteria, and they ask about medical conditions in the family, such as depression or substance use.⁠^2,30

Should children be screened for depression?

Teens, yes. The US Preventive Services Task Force recommends screening all adolescents aged 12 to 18 for major depressive disorder, and AAP-endorsed guidelines recommend a yearly screen from age 12.⁠^12,30

For children 11 and younger, the Task Force found the evidence insufficient to weigh the benefits and harms of screening. The risk factors it lists include a family history of depression, earlier depression, abuse or neglect, trauma, and bullying.⁠¹²

What kind of doctor diagnoses mood disorders in children?

Your child’s pediatrician is usually the first stop and may diagnose and treat depression or refer you on.⁠^1,5 A child and adolescent psychiatrist, a psychologist or another trained mental health professional makes a full evaluation, which is especially important when bipolar disorder is possible.⁠^2,16

Other routes to help:

• SAMHSA’s National Helpline, 1-800-662-HELP (4357). A free, confidential treatment referral and information service, open 24/7 in English and Spanish, that refers callers to local treatment, support groups and community organizations.⁠³¹
• AACAP’s Child and Adolescent Psychiatrist Finder. It lists psychiatrists who have told AACAP they care for children and teens; the listings are self-reported, and AACAP does not endorse them.⁠³²
• Your child’s school. Ask the school counselor or psychologist about an evaluation for special education under IDEA or for a Section 504 plan.⁠^33,34
• Your health plan. Call its behavioral health or member services line and ask which child mental health clinicians it covers.

How are mood disorders treated in children?

With psychotherapy, medication or both, chosen for the specific diagnosis, and usually with parents involved.⁠^5,23 Early treatment matters: the earlier it starts, the more effective it can be.⁠²⁵

Which therapies help children with depression?

Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have the most evidence for depression in children and teens.⁠^12,13 In trials reviewed for the Task Force, psychotherapy improved symptoms compared with waitlists, usual care or placebo.⁠¹²

For mild depression, guidelines recommend active monitoring; for moderate or severe depression, evidence-based medication and psychotherapy, with close monitoring of side effects.⁠³⁵ For children aged 3 to 6, a parent-child therapy focused on emotion development lowered rates of depression in a trial of 229 families, compared with a waitlist.⁠³⁶

In a trial of 439 teens aged 12 to 17 with major depression, response rates after 12 weeks were 71.0% for the combination of an antidepressant and CBT, 60.6% for the medication alone, 43.2% for CBT alone and 34.8% for placebo.⁠³⁷

How is bipolar disorder treated in children?

Usually with medication plus therapy and education for the family. AACAP names mood-stabilizing medications such as lithium, or atypical antipsychotics, alongside psychotherapy, and NIMH names cognitive behavioral approaches and family-focused therapy.⁠^2,16

Because episodes tend to recur, ongoing treatment is recommended even when a child is well, and steady treatment works better than treatment that starts and stops.⁠^2,4 Antidepressants are used cautiously in bipolar depression because they can tip a person into hypomania or mania.⁠⁴

What medications treat mood disorders in children?

For depression, the FDA has approved two SSRI antidepressants for young people: fluoxetine from age 8, and escitalopram for ages 12 to 17.⁠¹² Antidepressants usually take several weeks to work, and sleep, appetite and energy often improve before mood does.⁠^1,38

All antidepressants carry an FDA boxed warning: children, teens and young adults under 25 may have more suicidal thoughts or behavior, especially in the first weeks or after a dose change, so they need close monitoring.⁠^12,38 If your child talks about suicide, use the crisis lines at the top of this page.

For bipolar disorder, mood stabilizers such as lithium and atypical antipsychotics are the most commonly prescribed medications.⁠^4,38 For DMDD, no medication is FDA-approved, and psychotherapy is often tried first.⁠³⁹

How can parents help a child with a mood disorder?

Parents make a real difference, alongside treatment. The AAP and NIMH suggest these steps.⁠^1,2

1. Talk, and listen without judgment. Ask directly how your child feels; children often answer honestly when asked.⁠¹
2. Learn about the condition. What looks like laziness or irritability can be a symptom, and hopelessness is a symptom, not reality.⁠¹
3. Stick with the treatment plan. Treatment works but can take a few weeks; keep going to therapy and give medicines as prescribed.⁠^1,2
4. Protect sleep, activity and food. Healthy amounts of exercise, sleep and nutritious food can help mood, and a regular sleep schedule helps.⁠^1,23
5. Make home safe. Remove or lock away guns, alcohol, medicines and harmful chemicals, and ask the doctor for a safety plan.⁠^1,30
6. Watch for patterns. Notice moods, triggers and changes, and keep a mood chart if the doctor suggests one.⁠²
7. Look after yourself. Caring for a child with a mood disorder is stressful; find support for yourself too.⁠²

Face-to-face time with friends and family matters; texting and social media are not a substitute for it.⁠¹

How can school help a child with a mood disorder?

Mood disorders can affect concentration and grades, so school support is often part of the plan.⁠^1,23 NIMH suggests asking the school whether accommodations such as an IEP are appropriate; examples include more time for tests or seating that reduces distraction.⁠⁵

Two federal laws can apply. Under IDEA, a child may qualify for special education under emotional disturbance, which includes a general pervasive mood of unhappiness or depression over a long period and to a marked degree that adversely affects educational performance.⁠³³ Section 504 covers a mental impairment that substantially limits a major life activity, such as learning.⁠³⁴ How to request a school evaluation has a sample letter you can adapt.

What is the outlook for children with mood disorders?

Mood disorders are treatable: there are several effective treatments for depression, and children with bipolar disorder can improve over time with treatment.⁠^2,13 They can also come back, so follow-up matters: depression in children and teens is strongly associated with depression again in adulthood.⁠¹²

Bipolar disorder is often episodic but usually lifelong; with treatment, children and teens can manage their symptoms and lead full, active lives.⁠² Children with DMDD are more likely to develop anxiety and depression later.⁠¹⁵

Starting early helps: for a young person with symptoms of a mental disorder, the earlier treatment starts, the more effective it can be.⁠²⁵

Related on DrSensory

• Childhood depression

  How depression looks in children, the signs that need urgent attention, and how to get help.

• Persistent depressive disorder

  Long-lasting low or irritable mood in children, and what helps.

• DMDD

  Symptoms, DSM-5 criteria, causes and treatment of disruptive mood dysregulation disorder.

• Bipolar disorder in children and teens

  What bipolar disorder involves in young people, and how it is assessed.

• Generalized anxiety disorder

  Signs by age, causes, screening and treatment of GAD in children.

• Social anxiety in children

  Symptoms by age, causes and treatment of social anxiety disorder.

• ADHD in children

  Signs, diagnosis and support for ADHD.

• Teens, 13 to 17

  The teen brain and sleep, anxiety, depression, and when to get help.

• Substance use and neurodivergent teens

  Signs worth acting on, and how to keep the conversation open.

Sources

1. American Academy of Pediatrics, HealthyChildren.org. Depression in Children and Teens. Last updated September 12, 2022. Checked October 23, 2026.
   Show the passageHide the passage

   “Depression is a mood disorder that causes sadness and related symptoms to be more intense or last longer than usual after a difficult event”; “It is normal for grief to lessen over time”; “Depression can also occur without a triggering event”; “Children may have depression if their symptoms, which may include sadness, occur every day for more than 2 weeks”; “Any of these signs can occur in children who are not depressed, but when seen together, nearly every day, they are red flags for depression”. The two most common signs: “Seems more sad and irritable than usual, in a low mood for most of the day”; “No longer enjoys activities that used to make them happy”; others: “Spending more time alone and less time with friends”, “Trouble falling or staying asleep, or sleeps more than usual”, “Struggling or failing at school”, “A marked change in weight or eating, either up or down”, “Has less energy or motivation than usual for even simple tasks”, “Cries more often or mentions feeling sad, worthless or guilty about things”; “Children and teens may not always know how to describe what they are feeling”. “As many as 1 in 5 adolescents has depression at some point during their teen years. Every year, about 1 out of 11 adolescents has an episode of major depression”; “Experts estimate that between 2% and 3% of children aged 3 to 11 years have depression. Although it is not common, children as young as 3 years have been diagnosed with depression”; “Usually, a doctor diagnoses persistent depressive disorder when symptoms last for more than a year”; “This type of depression is less severe”; “A child with persistent depressive disorder may also have an episode of major depression at the same time”; “More trouble focusing or making choices”. “Often children or adolescents do not bring up the topic of their feelings but may respond honestly if you ask directly”; “Encourage them to share their feelings by listening without judgment”; “If your child has depression, the doctor may provide treatment or refer your family to a mental health specialist for treatment”; “Make sure they follow the treatment plan, attending therapy and taking any medicines prescribed as directed”; “if you notice signs of depression for more than two weeks, talk with your child’s doctor”; “many screen patients for depression every year from ages 12 through 21”; “Although treatment of depression works, it may take a few weeks”; “A child who feels depressed is not making up symptoms. What might look like laziness or irritability is a symptom of depression”; “Let your child know that feelings of hopelessness are a symptom of depression and are not an accurate picture of reality”; “Encourage them to get a healthy amount of exercise, sleep and nutritious foods, which can help boost mood”; “Communicating by text or social media isn’t a substitute for face-to-face time with friends or family in person”; “Remove guns and other weapons, alcohol, medicines and harmful household chemicals”; “You can ask your child or teen’s doctor for a safety plan you can fill out”.
2. National Institute of Mental Health. Bipolar Disorder in Children and Teens. NIH Publication No. 23-MH-8081, revised 2023. Checked October 23, 2026.
   Show the passageHide the passage

   “With treatment, children and teens with bipolar disorder can improve over time”; “It is a common misperception that children cannot have bipolar disorder. Although most people are diagnosed with bipolar disorder in adolescence or adulthood, the symptoms can appear earlier in childhood”; “Bipolar disorder is not the same as the typical ups and downs every child goes through”; “The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly”; “Bipolar disorder is often episodic, but it usually lasts a lifetime”; “These mood and activity changes are very different from the child’s usual behavior and the behavior of healthy children and teens”; “These mood episodes cause symptoms that often last for several days or weeks”. Manic episode: “Show intense happiness or silliness for long periods of time”, “Have a very short temper or seem extremely irritable”, “Have trouble sleeping but do not feel tired”, “Do risky or reckless things that show poor judgment”; depressive episode: “Complain a lot about physical pain, such as stomachaches and headaches”. “Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders”; “The exact causes of bipolar disorder are unknown, but several factors may contribute to the illness”; “a person’s chances of having bipolar disorder are higher if they have a close family member with the illness”; “just because one family member has bipolar disorder does not mean other family members will have it”; “people with a genetic risk of having bipolar disorder may be more likely to develop the disorder after experiencing trauma or other stressful life events”; “Some research studies have found differences in brain structure and function between people with bipolar disorder and people without it”. “There are no blood tests or brain scans that can diagnose bipolar disorder”; “the health care provider may use tests to determine if something other than bipolar disorder is causing your child’s symptoms”; “Health care providers may need to know about medical conditions in the family, such as depression or substance use”; look-alikes include “disruptive mood dysregulation disorder, oppositional defiant disorder, conduct disorder, and anxiety disorders”. “Steady, dependable treatment works better than treatment that starts and stops”; “Do not stop giving your child a prescribed medication without speaking to a health care provider”; “Always tell your child’s health care provider about any medication side effects”; research-based therapies include “cognitive behavioral approaches and family-focused therapy”; “keeping a daily life chart or mood chart to track your child’s moods, behaviors, and sleep patterns”; “If your child shows signs of suicidal thinking, take these signs seriously and call your child’s health care provider”; “A health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist”; “It is important that caregivers take care of themselves, too”; “Talk to your child’s health care provider about any symptoms you notice”; “Pay attention to your child’s moods, and be alert to any major changes”; “Understand triggers and learn strategies for managing intense emotions and irritability”; “Caring for a child or teenager with bipolar disorder can be stressful for parents and families”; “With treatment, children and teens with bipolar disorder can manage their symptoms and lead full, active lives”.
3. American Psychiatric Association. What Is Depression?. Physician review by Chinenye Onyemaechi, MD, April 2024. Checked October 23, 2026.
   Show the passageHide the passage

   “Feeling sad, irritable, empty and/or hopeless”; “a diagnosis of depression requires that the above symptoms occur for most of the day, nearly every day, for more than two weeks, along with a clear change in day-to-day functioning”; “if one identical twin has depression, the other has a 70 percent chance of having the illness sometime in life”; “a physical examination should be performed to screen for underlying medical conditions that may mimic depression”, “such as hormonal imbalances, vitamin deficiencies, neurological problems and drug or alcohol use”; “Grief and depression can co-exist”. Related conditions: persistent depressive disorder, “In children and adolescents, the mood can be irritable or depressed, and must continue for at least one year”; “Premenstrual dysphoric disorder (PMDD) was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013”; “A woman with PMDD has severe symptoms of depression, irritability, and tension about a week before menstruation begins”; “Disruptive mood dysregulation disorder is a mood condition that is diagnosed in children and youth ages 6 to 18”; “It involves a chronic and severe irritability resulting in severe and frequent temper outbursts”; “symptoms must begin before the age of 10 and be present for at least one year in at least two settings”; “It may occur along with other disorders, including major depressive, attention-deficit/hyperactivity, anxiety, and conduct disorders”.
4. American Psychiatric Association. What Are Bipolar Disorders?. Physician review by Adrian Preda, MD, April 2024. Checked October 23, 2026.
   Show the passageHide the passage

   “Bipolar disorder is a category that includes three main diagnoses: bipolar I, bipolar II, and cyclothymic disorder”; “A manic episode is a period of at least one week when a person is extremely high-spirited or irritable most of the day for most days, possesses more energy than usual”; “These behaviors must represent a change from the person’s usual behavior and be clear to friends and family”; hypomania involves “less severe manic symptoms that need to last only four days in a row rather than a week”; bipolar II requires “at least one major depressive episode and at least one hypomanic episode”; “Cyclothymic disorder is a milder form of bipolar disorder”, with “many periods of hypomanic and depressive symptoms, but the symptoms do not meet the criteria for hypomanic or depressive episodes”; “Some people with bipolar I disorder also experience depressive or hypomanic episodes”; “Medications known as “mood stabilizers” (e.g., lithium, atypical antipsychotics) are the most commonly prescribed type of medications for bipolar disorder”; “Because bipolar disorder is a chronic illness in which mood episodes typically recur, ongoing preventive treatment is recommended”; “Antidepressants are used cautiously for the treatment of bipolar-associated depression”, “as they increase the risk of switching depression into hypomania and mania”.
5. National Institute of Mental Health. Children and Mental Health: Is This Just a Stage?. Checked October 23, 2026.
   Show the passageHide the passage

   “All children are sad, anxious, irritable, or aggressive at times”; “In most cases, these are just typical developmental phases”; “Examples include anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), depression and other mood disorders”; “Consider seeking help if your child’s behavior or emotions last for weeks or longer, cause distress for your child or your family, or interfere with your child’s functioning at school, at home, or with friends”; “If your child’s behavior is unsafe, or if your child talks about wanting to hurt themselves or someone else, seek help immediately”. An evaluation usually involves “A parent interview to discuss the child’s developmental history, temperament, relationships with friends and family, medical history, interests, abilities, and any prior treatment”, “Information gathering from the child’s school, such as standardized test scores and reports on behavior, capabilities, and difficulties” and “If needed, an interview with the child for testing and behavioral observations”. “You can talk with your child’s pediatrician or health care provider” and “ask the health care provider for a referral to a mental health professional with experience and expertise in evaluating and treating children”. Treatment: “Parent involvement in the treatment”; “Medications, which will depend on the diagnosis and may include antidepressants, stimulants, mood stabilizers, or other medications”; “Medications are often used in combination with psychotherapy”; “Family counseling”. “A first step may be to ask the school whether accommodations such as an individualized education program (IEP) are appropriate for your child”; accommodations might include “allowing more time for tests, or adjusting seating in the classroom to reduce distraction”. “call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org”. “In life-threatening situations, call 911”.
6. Crisis Text Line. Crisis Text Line | Text HOME to 741741 Free, 24/7 Mental Health Support. “Text HOME to 741741 from anywhere in the United States – 24/7, free, confidential”; “A live, trained volunteer Crisis Counselor will receive your text and respond with care and compassion”. Checked October 23, 2026.
7. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Rockville, MD: SAMHSA; June 2016. Checked October 23, 2026.
   Show the passageHide the passage

   In the DSM-5, “numerous individual disorders were reclassified from one class to another (e.g., from “mood disorders” to “bipolar and related disorders” or “depressive disorders”)”. The class of DMDD: “Disruptive Mood Dysregulation Disorder (or DMDD) (under Depressive Disorders)”. Major depression: “depressed mood or loss of interest or pleasure lasting for most of the day, nearly every day for 2 weeks or more”; “The primary symptom (depressed mood or loss of interest/pleasure) must be accompanied by four or more additional symptoms and must cause clinically significant distress or impairment”; “(in children and adolescents, can be irritable mood)”; “(in children, failure to make expected weight gains)”; “Sleep disturbance (insomnia or hypersomnia)”; “Tiredness, fatigue, or low energy”; “A sense of worthlessness or excessive, inappropriate, or delusional guilt”; “Impaired ability to think, concentrate, or make decisions”; “Recurrent thoughts of death”; “The symptoms are not due to the direct physiological effects of a substance (e.g., drug abuse, a prescribed medication’s side effects) or a medical condition (e.g., hypothyroidism)”; “MDE/MDD should not be confused with normal and appropriate grief”. Persistent depressive disorder: “a persistently depressed mood that occurs most of the day, for more days than not, for a period of at least 2 years”; “In children and adolescents, mood can be irritable and duration must be at least 1 year”; “Presence while depressed of two or more of the following”; “Criteria for MDD may be continuously present for 2 years, in which case patients should be given comorbid diagnoses of persistent depressive disorder and MDD”. Mania: “a period of abnormally and persistently elevated, expansive, or irritable mood that is accompanied by increased energy or activity”; “symptoms must represent a noticeable change from usual behavior”; “Bipolar I disorders are characterized by one or more manic episodes or mixed episodes and one or more MDEs”. “When all symptom, severity, and frequency criteria are applied, DMDD is only present in roughly 1 percent of school-aged children”.
8. Bitsko RH, Claussen AH, Lichstein J, et al. Mental health surveillance among children – United States, 2013–2019. MMWR Suppl. 2022;71(2):1–42. doi:10.15585/mmwr.su7102a1 (PMID 35202359; PMC8890771). Checked October 23, 2026.
   Show the passageHide the passage

   “an estimated 4.4% children and adolescents aged 3–17 years ever had diagnosed depression, and 3.4% had current depression”; “the prevalence was 0.1% for children aged 3–5 years, 2.3% for children aged 6–11 years, and 8.6% for adolescents aged 12–17 years”.
9. Leibenluft E. Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. American Journal of Psychiatry. 2011;168(2):129–142. doi:10.1176/appi.ajp.2010.10050766 (PMID 21123313; PMC3396206). Checked October 23, 2026.
   Show the passageHide the passage

   “nonepisodic irritability in youths is common and is associated with an elevated risk for anxiety and unipolar depressive disorders, but not bipolar disorder, in adulthood”; “youths with severe mood dysregulation have lower familial rates of bipolar disorder than do those with bipolar disorder”.
10. Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry. 2007;64(9):1032–1039. doi:10.1001/archpsyc.64.9.1032 (PMID 17768268). Checked October 23, 2026.
    Show the passageHide the passage

    Youth office-based visits with a bipolar diagnosis “increased from 25 (1994-1995) to 1003 (2002-2003) visits per 100,000 population”; “There has been a recent rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings”.
11. Sun CF, Correll CU, Wei CY, Kim SJ. Disruptive mood dysregulation disorder and pediatric bipolar disorder: diagnostic and prescribing trends following DSM-5. European Child & Adolescent Psychiatry. 2026 (online ahead of print). doi:10.1007/s00787-026-03097-1 (PMID 42319434). Checked October 23, 2026.
    Show the passageHide the passage

    “Disruptive mood dysregulation disorder (DMDD) was introduced in DSM-5 in 2013 to address concerns about overdiagnosis of pediatric bipolar disorder in chronically irritable children”. Electronic health records, 2003–2025, “among patients aged 6-18 years”: “Following DMDD introduction, DMDD diagnoses increased steadily while bipolar disorder diagnoses declined”; “Antipsychotic and mood stabilizer prescribing did not show immediate changes and declined later in the study period”; “Data-driven analyses identified a change point in bipolar disorder diagnoses in 2009, several years before DMDD introduction”; “The decline in bipolar diagnoses most likely reflects accumulating evidence against the validity of broad bipolar diagnoses in chronically irritable children, rather than a direct effect of DMDD’s introduction”; “Diagnostic trends should be interpreted with caution, particularly when the validity of the diagnostic categories themselves remains unclear”.
12. US Preventive Services Task Force. Depression and Suicide Risk in Children and Adolescents: Screening. Final recommendation, October 11, 2022. Checked October 23, 2026.
    Show the passageHide the passage

    “The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years”; “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for MDD in children 11 years or younger”; risk factors “include family history of depression, prior episodes of depression, childhood abuse or neglect, exposure to traumatic events or stress, bullying, maltreatment, adverse life events, and a difficult relationship with parents”; “Major depressive disorder (MDD) in children and adolescents is strongly associated with recurrent depression in adulthood”; “Suicide is the second-leading cause of death among youth aged 10 to 19 years”; “cognitive behavioral therapy and interpersonal therapy have the most evidence supporting their effectiveness”; “fluoxetine is the only medication approved by the US Food and Drug Administration (FDA) for use in treating MDD in children 8 years or older; escitalopram is approved to treat MDD in adolescents aged 12 to 17 years”; “Fluoxetine and escitalopram, both selective serotonin reuptake inhibitors”; “The FDA has issued a boxed warning for antidepressants, recommending that patients of all ages who start antidepressant therapy be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior”; “GLAD-PC is supported by the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association”; “Pooled estimates demonstrated that psychotherapy, compared with wait-list controls, treatment as usual, attention control, or placebo, was associated with improved symptoms”.
13. American Academy of Child and Adolescent Psychiatry. Depression in Children and Teens. Facts for Families No. 4, updated October 2018. Checked October 23, 2026.
    Show the passageHide the passage

    “Occasional sadness is a normal part of growing up”; “Caring less about school or not doing as well in school”; “Sometimes it seems to come out of nowhere”; “try asking them how they are feeling and if there is anything bothering them”; “ask your child questions about their mood or ask them to fill out a brief survey”; “The good news is that there are several effective treatments for depression”; “if children are sad, irritable, or no longer enjoy things, and this occurs day after day, it may be a sign that they are suffering from major depressive disorder”; “Children also may have more physical complaints, such as frequent headaches or stomach aches”; “Depressed adolescents may use alcohol or other drugs as a way of trying to feel better”; “Other times, it happens when children are under stress or after losing someone close to them”; “Bullying and spending a lot of time using social media may be associated with depression”; “Depression can run in families”; “Having another condition such as attentional problems, learning issues, conduct or anxiety disorders also puts children at higher risk for depression”; “These statements should be taken very seriously because depressed children and adolescents are at increased risk of self harm”; “Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of psychotherapy shown to be effective in treating depression”.
14. US Department of Health and Human Services, Office on Women’s Health. Premenstrual dysphoric disorder (PMDD). Checked October 23, 2026.
    Show the passageHide the passage

    “PMDD causes severe irritability, depression, or anxiety in the week or two before your period starts”; “Symptoms usually go away two to three days after your period starts”; “You will need to keep a calendar or diary of your symptoms to help your doctor diagnose PMDD”.
15. National Institute of Mental Health. Disruptive Mood Dysregulation Disorder (DMDD). “DMDD is a mood disorder in which children and adolescents experience ongoing irritability and anger and have frequent, intense temper outbursts”; children with DMDD are “more likely to develop anxiety and depression in the future”. Checked October 23, 2026.
16. American Academy of Child and Adolescent Psychiatry. Bipolar Disorder in Children and Teens. Facts for Families No. 38, updated March 2017. Checked October 23, 2026.
    Show the passageHide the passage

    “Children with bipolar disorder have periods (or episodes) of mania and depression”; “Decreased need for sleep such as being able to go with little or no sleep for days without feeling tired”; “Some of these signs are similar to those that occur in children and adolescents with other problems such as drug abuse, attention-deficit hyperactivity disorder, major depressive disorder, disruptive mood dysregulation disorder, or even schizophrenia”; “if one or both parents have bipolar disorder, the chances are greater that their children may develop the disorder”; “The diagnosis of bipolar disorder in children and teens is complex and involves careful observation over an extended period of time”; “A comprehensive evaluation by a child and adolescent psychiatrist or trained mental health professional can help identify bipolar disorder”; “Treatment for bipolar disorder usually includes education of the patient and the family about the illness, mood stabilizing medications such as lithium, or atypical antipsychotics, and psychotherapy”.
17. American Academy of Pediatrics, HealthyChildren.org. Bipolar Disorder in Children and Teens: Beyond Normal Ups and Downs. Last updated May 22, 2023. Checked October 23, 2026.
    Show the passageHide the passage

    “Around 1% to 2% of all U.S. kids under 18 live with bipolar disorder”; “Children and adolescents are more likely to have mood fluctuation even within the acute manic or depressive episodes they experience”; “Kids living with bipolar disorder might also show symptoms that are confusingly similar to those of other common childhood disorders”; “Until recently, many believed that bipolar disorder could not be diagnosed until the early to mid-20s”; “Newer studies have helped us understand that many kids do, in fact, live with bipolar disorder”.
18. National Institute of Mental Health. Major Depression (statistics). Checked October 23, 2026.
    Show the passageHide the passage

    “The past year prevalence data presented here for major depressive episode are from the 2021 National Survey on Drug Use and Health (NSDUH)”; “An estimated 5.0 million adolescents aged 12 to 17 in the United States had at least one major depressive episode. This number represented 20.1% of the U.S. population aged 12 to 17”; “The prevalence of major depressive episode was higher among adolescent females (29.2%) compared to males (11.5%)”; “In 2021, an estimated 40.6% of U.S. adolescents with major depressive episode received treatment in the past year”.
19. National Institute of Mental Health. Bipolar Disorder (statistics). Checked October 23, 2026.
    Show the passageHide the passage

    From the adolescent part of the National Comorbidity Survey (NCS-A), “lifetime prevalence of bipolar disorder among U.S. adolescents aged 13-18”: “An estimated 2.9% of adolescents had bipolar disorder, and 2.6% had severe impairment”; “The prevalence of bipolar disorder among adolescents was higher for females (3.3%) than for males (2.6%)”; the years: “Lifetime Prevalence of Bipolar Disorder Among Adolescents (2001-2004)”.
20. Van Meter A, Moreira ALR, Youngstrom E. Updated meta-analysis of epidemiologic studies of pediatric bipolar disorder. Journal of Clinical Psychiatry. 2019;80(3):18r12180. doi:10.4088/jcp.18r12180 (PMID 30946542). Checked October 23, 2026.
    Show the passageHide the passage

    “a total sample of 19 studies”; “Weighted average prevalence of bipolar spectrum disorders was 3.9% (95% CI, 2.6%-5.8%)”; “Nonstandard diagnostic criteria result in highly variable prevalence rates”; “rates of bipolar spectrum disorders are not higher in the United States than in other Western countries, nor are rates increasing over time”.
21. Verlenden JV, Fodeman A, Wilkins N, et al. Mental health and suicide risk among high school students and protective factors – Youth Risk Behavior Survey, United States, 2023. MMWR Suppl. 2024;73(4):79–86. doi:10.15585/mmwr.su7304a9 (PMID 39378246; PMC11559681). Checked October 23, 2026.
    Show the passageHide the passage

    “Overall, 39.7% of students experienced persistent feelings of sadness and hopelessness, 28.5% experienced poor mental health, 20.4% seriously considered attempting suicide, and 9.5% had attempted suicide”.
22. Weissman MM, Wickramaratne P, Nomura Y, Warner V, Pilowsky D, Verdeli H. Offspring of depressed parents: 20 years later. American Journal of Psychiatry. 2006;163(6):1001–1008. doi:10.1176/ajp.2006.163.6.1001 (PMID 16741200). Checked October 23, 2026.
    Show the passageHide the passage

    “The authors followed 151 offspring of moderately to severely depressed parents or nonpsychiatrically ill comparison subjects for about 20 years”; “The risks for anxiety disorders, major depression, and substance dependence were approximately three times as high in the offspring of depressed parents as in the offspring of nondepressed parents”; “The period of highest incidence for major depressive disorder remained between ages 15 and 20 years, largely in females”.
23. National Institute of Mental Health. Teen Depression: More Than Just Moodiness. NIMH Identification No. OM 22-4321. Checked October 23, 2026.
    Show the passageHide the passage

    “If you have been feeling sad most of the time for a few weeks or longer and you’re not able to concentrate or do the things you used to enjoy, talk to a trusted adult about depression”; “Do you get easily frustrated, irritable, or angry?”; “Are your grades dropping?”; “Depression can be treated with psychotherapy (also called “talk therapy”), medication, or a combination of medication and talk therapy”; “Try to keep a regular sleep schedule”.
24. National Institute of Mental Health. Warning Signs of Suicide. Revised 2025. Checked October 23, 2026.
    Show the passageHide the passage

    Talking about “Wanting to die”, “Great guilt or shame”, “Being a burden to others”; feeling “Empty, hopeless, trapped, or having no reason to live”; changing behavior: “Making a plan or researching ways to die”, “Withdrawing from friends, saying goodbye, giving away important items, or making a will”, “Displaying extreme mood swings”, “Eating or sleeping more or less”, “Using drugs or alcohol more often”; “get help as soon as possible, particularly if the behavior is new or has increased recently”.
25. National Institute of Mental Health. Child and Adolescent Mental Health. Checked October 23, 2026.
    Show the passageHide the passage

    “For a young person with symptoms of a mental disorder, the earlier treatment is started, the more effective it can be”; younger children may benefit from an evaluation if they “Have frequent tantrums or are intensely irritable much of the time”; older children if they “Have periods of highly elevated energy and activity and require much less sleep than usual”; NIH researchers “found that rates of preteen suicide (ages 8-12) have been increasing by approximately 8% annually since 2008”.
26. American Academy of Pediatrics, HealthyChildren.org. Top Tips for Surviving Tantrums. Last updated April 21, 2021. “Tantrums are a normal part of development. They happen most between ages 1 and 3 years”; “Tantrums do tend to get better after the age of 3”. Checked October 23, 2026.
27. National Institute of Mental Health. Depression. “Research suggests that genetic, biological, environmental, and psychological factors play a role in depression”; “It is also a risk factor for suicidal thoughts and behaviors”. Checked October 23, 2026.
28. Hudson CC, Hall L, Harkness KL. Prevalence of depressive disorders in individuals with autism spectrum disorder: a meta-analysis. Journal of Abnormal Child Psychology. 2019;47(1):165–175. doi:10.1007/s10802-018-0402-1 (PMID 29497980). Checked October 23, 2026.
    Show the passageHide the passage

    “Sixty-six articles met inclusion criteria”; “the pooled lifetime and current prevalence was 14.4% (95% CI 10.3-19.8) and 12.3% (95% CI 9.7-15.5), respectively”; “individuals with ASD are 4-times more likely to experience depression in their lifetime”.
29. American Academy of Child and Adolescent Psychiatry. Impairing Emotional Outbursts: Parents’ Medication Guide. 2021. Checked October 23, 2026.
    Show the passageHide the passage

    Autistic children “can have outbursts when they are upset by change in routine or environment, they are overwhelmed by loud noises or bright lights, or they don’t understand what is being said to them”; “Outbursts may also occur with some medical problems like epilepsy (seizures) or some hormone problems (such as diabetes or thyroid issues)”.
30. Zuckerbrot RA, Cheung A, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018;141(3):e20174081. doi:10.1542/peds.2017-4081 (PMID 29483200). Checked October 23, 2026.
    Show the passageHide the passage

    “Guidelines were updated for youth aged 10 to 21 years”; recommendations include “annual universal screening of youth 12 and over at health maintenance visits”, “systematic assessment procedures by using reliable depression scales, patient and caregiver interviews” and “the establishment of a safety plan”.
31. Substance Abuse and Mental Health Services Administration. SAMHSA’s National Helpline. “SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders”; “1-800-662-HELP (4357)”; “This service provides referrals to local treatment facilities, support groups, and community-based organizations”. Checked October 23, 2026.
32. American Academy of Child and Adolescent Psychiatry. Child and Adolescent Psychiatrist Finder. Checked October 23, 2026.
    Show the passageHide the passage

    The finder is “designed to help parents and other adults who are seeking psychiatric care for their children to locate psychiatrists who have reported to AACAP that they are providers of psychiatric care for children and adolescents”; “The information available through the Psychiatrist Finder is self-reported by AACAP members”; “AACAP does not give endorsements or recommendations concerning any particular psychiatrists”.
33. Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 300.8 Child with a disability. Checked October 23, 2026.
    Show the passageHide the passage

    Paragraph (a)(1): “Child with a disability means a child evaluated in accordance with §§ 300.304 through 300.311”; paragraph (c)(4): emotional disturbance means “a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance”, including “A general pervasive mood of unhappiness or depression”.
34. Section 504 regulations, Electronic Code of Federal Regulations. 34 CFR § 104.3 Definitions. Checked October 23, 2026.
    Show the passageHide the passage

    Paragraph (j), “Handicapped person” (the regulation’s own term for a person with a disability): “has a physical or mental impairment which substantially limits one or more major life activities”; mental impairments include “any mental or psychological disorder, such as intellectual disability, organic brain syndrome, emotional or mental illness, and specific learning disabilities”; major life activities include “learning”.
35. Cheung AH, Zuckerbrot RA, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics. 2018;141(3):e20174082. doi:10.1542/peds.2017-4082 (PMID 29483201). Recommendations include “active monitoring of mildly depressed youth”, “treatment with evidence-based medication and psychotherapeutic approaches in cases of moderate and/or severe depression” and “close monitoring of side effects”. Checked October 23, 2026.
36. Luby JL, Barch DM, Whalen D, Tillman R, Freedland KE. A randomized controlled trial of parent-child psychotherapy targeting emotion development for early childhood depression. American Journal of Psychiatry. 2018;175(11):1102–1110. doi:10.1176/appi.ajp.2018.18030321 (PMID 29921144; PMC6309340). Checked October 23, 2026.
    Show the passageHide the passage

    The published abstract: “Clinical depression in children as young as age 3 has been validated, and prevalence rates are similar to the school-age disorder”; “229 parent-child dyads with children 3-6.11 years of age”; “Children in the PCIT-ED group had lower rates of depression (primary outcome), lower depression severity, and lower impairment compared with those in the waiting list condition”.
37. March J, Silva S, Petrycki S, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004;292(7):807–820. doi:10.1001/jama.292.7.807 (PMID 15315995). Checked October 23, 2026.
    Show the passageHide the passage

    “a volunteer sample of 439 patients between the ages of 12 to 17 years”; after twelve weeks, “Rates of response for fluoxetine with CBT were 71.0% (95% confidence interval [CI], 62%-80%); fluoxetine alone, 60.6% (95% CI, 51%-70%); CBT alone, 43.2% (95% CI, 34%-52%); and placebo, 34.8% (95% CI, 26%-44%)”; “The combination of fluoxetine with CBT offered the most favorable tradeoff between benefit and risk for adolescents with major depressive disorder”.
38. National Institute of Mental Health. Mental Health Medications. Checked October 23, 2026.
    Show the passageHide the passage

    “problems with sleep, appetite, energy, and concentration often improve before mood lifts”; “In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting the medication or when the dose is changed”; “Mood stabilizers are typically used to treat bipolar disorder”; lithium, “an effective mood stabilizer, is approved for the treatment of mania and bipolar disorder”.
39. National Institute of Mental Health. Disruptive Mood Dysregulation Disorder: The Basics. “In many cases, psychotherapy is considered first, with medication added later”; “Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) specifically for treating children or adolescents with DMDD”. Checked October 23, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. If you are worried about immediate safety, call or text 988 (US). Never start, stop, or change a dose without medical guidance.