Almost everyone has weeks when the mood dips — a hard stretch at work, a loss, a change that throws things off balance for a while. What I’m listening for in a first evaluation is something different: a mood that has settled in and stayed, out of proportion to whatever is going on around it. That shift is usually where the word depression starts to apply.
It’s a condition I see across the full age range I treat — young children, teenagers, adults, and older adults — and while the underlying biology has a good deal in common from one age group to the next, the way it shows up on the surface can look quite different depending on who is sitting across from me.
Recognizing the signs
In adults, the presentation is often close to what people expect: persistent sadness or a flat, joyless mood, loss of interest in things that used to bring pleasure, fatigue, disrupted or excessive sleep, guilt, and a mental fog that makes concentration and decision-making harder than usual. Appetite and interest in sex often shift as well, and social withdrawal tends to follow close behind.
- Persistent sadness or a flat, joyless mood most of the day
- Irritability, which is often more prominent in children and teenagers than sadness itself
- Fatigue or loss of energy, even after adequate rest
- Sleep disturbance — too little, or too much
- Difficulty concentrating, remembering, or making decisions
- Loss of interest in activities that used to feel rewarding
- Withdrawal from friends, family, or everyday routines
In children, the same underlying condition often looks less like sadness and more like irritability, physical complaints, or a drop in school performance that a teacher notices before a parent does. Thoughts of self-harm can appear at any age, and always warrant immediate attention regardless of how mild the rest of the picture seems.
What a psychiatric evaluation involves
A thorough evaluation isn’t a checklist. I want to understand the current episode — when it started, whether anything specific triggered it — along with any past episodes, family psychiatric history, substance use, trauma history, medical history, and the social and educational context someone is living in. For a child, that usually means talking with parents and, when it’s appropriate, with the school as well as the child directly.
Therapy, medication, or both
Depression is treated through psychotherapy, medication, or a combination of the two, and there isn’t one right answer that applies to everyone. I walk through the realistic benefits and drawbacks of each option with every patient — or with parents, in the case of a child — so the decision that gets made is genuinely informed rather than automatic.
Whether depression is showing up for the first time or it’s a pattern that has returned, the starting point is the same: a careful look at what’s actually happening, at whatever age it’s happening. That’s where I’d want to begin.