GPAtlas🧭 When to suspect
Suspect depression in a child or young person presenting with a persistent low mood, or a marked loss of interest or pleasure in activities (anhedonia), that represents a change from their usual self. Look for associated features – disturbed sleep or appetite, fatigue, feelings of worthlessness or guilt, poor concentration, and irritability, which is often more prominent than sadness in younger children.
To meet the threshold for depression, symptoms should be present most days for at least 2 weeks and cause functional impairment – at home, at school and socially. NICE NG134 covers ages 5 to 18 and uses a stepped-care model; the two key skills in primary care are to match management to severity and to assess risk at every contact.
| Severity | Typical picture | Primary-care action |
|---|---|---|
| Mild | Core symptoms with few others; able to continue most daily activities | Tier 1 – watchful waiting (review within 2 weeks), then psychological therapy |
| Moderate | Several symptoms beyond the core; considerable difficulty functioning | Refer CAMHS (tier 2/3) for review |
| Severe | Most symptoms, marked distress and functional loss; may include psychotic features | Refer CAMHS (tier 2/3); urgent if active suicidality, psychosis or self-neglect |
Core symptoms are persistent low mood or irritability, loss of interest or pleasure, and reduced energy or fatigue, present most days for at least 2 weeks. Raise your index of suspicion with a family history of depression or bipolar disorder, recent psychosocial stressors (bullying, family breakdown, bereavement), a history of abuse or neglect, chronic illness, and coexisting anxiety, ADHD or autism.
Source: NICE NG134
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