Depression…Definitions matter

Sad boyThis is the first post in our Winter 2013 blog series Understanding Depression in Kids and Teens…A Primer for Pastors, Church Staff and Christian Parents. Today, we’ll introduce the criteria for what constitutes “depression” and discuss the importance of using the proper language with kids and teens in order to identify who might need help and increase the likelihood kids and families will get the most appropriate help.

Kids…and far too many professionals use the terms “sad” and “depressed” interchangeably. Sadness is emotional distress in response to loss, frustration, disappointment or sorrow. Depression is a medical syndrome of which ongoing sadness is one symptom. As a child and adolescent psychiatrist, when I use the term “depression,” I’m usually referring to the condition described in the DSM as Major Depressive Disorder. The diagnostic criteria for depression in children and teens are the same as in adults and are listed below…

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note:  Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations. 

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. 

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode. (Criteria met for both a manic episode as well as a Major Depressive Episode) 

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). 

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

ID-100105042My point in outlining the diagnostic criteria is that in our very broken and dysfunctional systems of medical/mental health care, harried primary care physicians who are often expected to treat 40-50 patients per day or psychiatrists expected to treat four patients per hour may latch onto the word “depression” without fully considering whether kids or teens they’re seeing actually meet the criteria for the medical syndrome described as Major Depression. There are lots of other medical and mental health conditions associated with signs and symptoms that overlap the criteria for Major Depression. Having been involved in federally funded research examining the safety of antidepressant medication in kids and teens, I’m of the opinion that the prevalence of depression in the pediatric population may be overestimated. More on that later.

The purpose of this series will be to help pastors, church staff, volunteers and Christian parents improve their ability to recognize the signs and symptoms of depression and children and teens and help them to most effectively support kids with depression and their families. Here’s a tentative outline of some of the topics we’ll be covering in the series…

  • Pediatric Depression…Statistics
  • What does a child/teen with depression look like?
  • What causes kids to become depressed?
  • Are they really depressed, or do they have something else?
  • Is an episodic disability still a disability?
  • What if Mom is depressed?
  • Finding help
  • Cognitive-behavioral therapy
  • How helpful is medication?
  • Should I give my child medication if they’ve been diagnosed with depression?
  • What can the church do to help families impacted by depression?
  • Tying it all together

Throughout the series, I’ll share links to helpful publications or resources for pastors, church staff and parents to share with families of kids who may be struggling with depression. Today, I’ll recommend this link to the National Institute of Mental Health’s webpage on depression in children and adolescents.

Photos courtesy of


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About Dr. G

Dr. Stephen Grcevich serves as President and Founder of Key Ministry, a non-profit organization providing free training, consultation, resources and support to help churches serve families of children with disabilities. Dr. Grcevich is a graduate of Northeastern Ohio Medical University (NEOMED), trained in General Psychiatry at the Cleveland Clinic Foundation and in Child and Adolescent Psychiatry at University Hospitals of Cleveland/Case Western Reserve University. He is a faculty member in Child and Adolescent Psychiatry at two medical schools, leads a group practice in suburban Cleveland (Family Center by the Falls), and continues to be involved in research evaluating the safety and effectiveness of medications prescribed to children for ADHD, anxiety and depression. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI). Dr. Grcevich was recently recognized by Sharecare as one of the top ten online influencers in children’s mental health. His blog for Key Ministry, was ranked fourth among the top 100 children's ministry blogs in 2015 by Ministry to Children.
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