Depressive Episode

The term “depressive episode” originates from medical diagnostics. In the International Classification of Diseases, 10th Revision (ICD-10), it is designated by the code F32. It refers to a continuous period of at least two weeks during which three areas are affected: mood is depressed, energy levels decline, and the ability to take pleasure in things that were once important is lost.

In children and adolescents, the picture often differs from the classic image of a sad, crying person. Toddlers may seem anxious, cling to others, or have severe outbursts of anger. School-age children may withdraw, lose interest in playing, and doubt themselves. Adolescents report persistent low mood, changes in sleep patterns, and sometimes the feeling that nothing makes sense anymore.

A single week of feeling down after an argument or a disappointment does not constitute a depressive episode. What matters is the duration and whether daily life is noticeably affected.

Many signs initially seem like phases that are part of growing up. That is exactly what makes them hard to recognize. It becomes noticeable when several signs occur together and persist for weeks:

• Persistent sadness or a strong, irritable mood
• The child’s social withdrawal from friends, hobbies, and family
• Sleep problems or, conversely, an extreme need for sleep
• Changes in appetite, weight fluctuations, complaints of stomachaches or headaches
• Declining performance and increasing anxiety about schoolwork
• Expressions of hopelessness, self-deprecation, or thoughts of death

The last point is one of the most important warning signs. Suicide is one of the leading causes of death among children and adolescents, and a large proportion of these cases is linked to depression. If a child suggests that they no longer want to live, this must be taken seriously and evaluated by a doctor.

Doctors classify depressive episodes based on their severity. This classification follows the ICD-10 and is based on the number of symptoms present and the extent to which daily life is impaired.

• Mild episode (F32.0): The child is suffering but can largely manage daily life with some effort.
• Moderate episode (F32.1): School, friendships, and family life are significantly impaired.
• Severe episode (F32.2 and F32.3): Daily life largely breaks down. In the most severe form, perceptual disturbances may also occur.

Approximately five out of every hundred children and adolescents exhibit symptoms indicative of depression. The good news from research: A large proportion recovers within one to two years. At the same time, about half experience a recurrence within a few years, which is why careful follow-up care remains important.

Treatment depends on the severity of the condition. For mild and moderate episodes, psychotherapy is the first line of treatment. Cognitive behavioral therapy and interpersonal psychotherapy have been well studied. Both have been shown to alleviate depressive symptoms in children and adolescents. In behavioral therapy, the child learns to recognize entrenched negative thought patterns and to gradually reengage with daily life.

Medication is primarily used for severe episodes, usually in addition to psychotherapy and under the supervision of a specialist. Antidepressants are often less effective in younger people than in adults and carry potential side effects, which is why their use is carefully weighed.

As parents, there is much you can do without being a therapist yourself: provide a reliable daily routine, encourage physical activity together, listen without immediately judging, and keep track of appointments. Feelings of guilt are a poor guide in this situation. Depression arises from a combination of genetic predisposition, biological processes, and stressful experiences such as bullying or a breakup—not from parenting mistakes.

If the symptoms persist for more than two weeks, it is advisable to seek a professional evaluation. Your child’s pediatrician can be your first point of contact; if necessary, they will refer you to a child and adolescent psychiatry clinic or a psychotherapy practice.

In cases of acute danger—for example, if your child mentions suicide—do not wait. Round-the-clock resources include the child and adolescent psychiatric clinic nearest you and the emergency number 112. You can also reach the “Nummer gegen Kummer” Children’s and Youth Helpline at 116 111 (Monday through Saturday, 2:00 p.m. to 8:00 p.m.) and the Parents’ Helpline at 0800 111 0550—both free of charge and anonymously. For more information, see the article “Crisis Hotline: Where and When Should I Call?”

Sometimes there is something else underlying the symptoms, such as post-traumatic stress disorder. Only a specialist can make such a distinction. “Rückenwind” (Parents) provides coaching and support to help you navigate this time as parents. We do not make diagnoses and do not replace treatment. The assessment and treatment of a depressive episode should be handled exclusively by a child and adolescent psychiatry (KJP) specialist or a medical or psychotherapeutic professional.