All that is Depressed is not Sad

I'm busy seeing kids at the clinic, and one question that keeps coming up (more from kids than parents) is "So you think I'm depressed? But I'm not sad." Teenagers often do not identify with the symptom of sadness that sometimes goes along with depression. They may identify themselves as more like these: moody, irritable, angry. Parents of depressed children often talk about their kid's "mood swings" which leads many to wonder about bipolar disorder. However, the vast, vast majority (and by vast, I'm talking 90%) of the kids that I see with "mood swings" have something other than bipolar disorder. The odds are that most of these children have a depression or anxiety problem (or both).

In the diagnostic criteria for Major Depressive Disorder, you don't actually need sadness to make the diagnosis. Other symptoms are just as important as the mood. The biggie is called Anhedonia- which literally means "lack of pleasure". Kids with depression find very little to be happy about, are very hard to please, don't get excited about stuff that used to be fun. Anhedonia is not exactly like sadness, but it is like a lack of happiness or enjoyment for life.