Depression and Dysthymia

by Leslie E. Packer, PhD
Last Updated January 2009




  • Depression is more common in females than males, but males report more functional impairment.
  • Over 13% of individuals experience major depression at some point in their life; during any 2-week period, over 1 in 20 people aged 12 and older will experience depression.
  • The average duration of a major depressive episode in adults is about 10 months.
  • Up to 10% of all children under age 13 experience a major depressive episode or depression.
  • 15 – 20% of teenagers experience a major depressive episode or depression.
  • Over 50% of adolescents who have depression turn to drugs.
  • Suicide is the third leading cause of death in the age group 10 – 24 (CDC, 2004).
  • Most suicidal adolescents are not known to be at risk by school officials.
  • The most common method used to commit suicide used to be guns, but in 1997, suffocation surpassed fireams as the most common method and remains the most common method at this time.
  • Nearly 60% of children whose parents and grandparents suffered from depression have a psychiatric disorder before they reach their early teens — more than double the rate who develop such disorders with no family history of depression.
  • Most of the children with a two-generation history of depression who develop depression first develop anxiety disorders that develop into depression as they become adolescents.
  • Depression in youth on average lasts several months and recurs in most patients.
  • Depression is more common in low-income and non-Hispanic black people.
  • Women are three times as likely to attempt suicide as men, but
  • Men are four times as likely as women to complete suicide.


Children and adolescents with depression may appear sad or blue, but depression may also be manifest as anger or chronic irritability.

Sleep disturbance, loss of interest in previously enjoyed activities, feelings of hopelessness, guilt, appetite changes, lack of energy, and auditory hallucinations (in severe cases) may all be signs of depression. Young children may report a lot of headaches or stomachaches for which there is no obvious reason.


“SAD FACES + GWV”” is an acronym to help you remember the signs and symptoms of depression in terms of what’s affected:

S = sleep changes
A = appetite
D = “down” mood

F = fun (lack of)
A = agitation
C = concentration
E = energy loss
S = suicidal thoughts

G = guilty feelings
W = feels worthless
V = voices (auditory hallucinations)


If there is any significant change in any student’s behavior that lasts more than two weeks, you should contact the child’s parent to inform them of your observations.


Some people just always seem to have the “blahs.” These may be the students that we think of as being depressed over the long term. They may always seen “down in the dumps” even if there’s nothing particularly depressing going on in their lives, and when asked, may tell you that they’ve “always” been this way. Or maybe they always seem “cranky” or slightly irritable. While symptoms in children may appear a bit different than in adults, the key features here are the duration of the depressed mood and the presence of at least two of the following symptoms we associate with the depressed mood:

  • change in appetite/eating habits
  • change in sleeping habits
  • low energy or fatigue
  • poor self-esteem
  • poor concentration or difficulty making decisions, and
  • feelings of hopelessness

By now, you will probably recognize the above as signs of depression.

But what happens to children with dysthymia? Do the symptoms progress into full-blown depression or do they remit? In some cases, they do evolve into Major Depression.

Hayden and Klein (2001) assessed 86 patients with early-onset dysthymia (i.e., prior to age 21) over a 5-year period. They found that a number of factors predicted outcome. Dysthymia was more likely to evolve into depression in cases where there was a family history of dysthymia, a history of poor childhood relationship with parents, childhood sexual abuse, cluster C features, neuroticism, a history of anxiety and eating disorders, and/or chronic stress.

Some individuals may suffer from both dysthymia and depression. They may spend most of their time in a mildly depressed (dysthymic) state but occasionally experience symptoms severe enough to be diagnosed as major depression. Some clinicians refer to this combination or pattern as a “double depression.” I think of it as “between a rock and a hard place.”


Cluster C personality disorders constitute the anxious/fearful set of personality disorders, and include Obsessive-Compulsive Personality Disorder, Avoidant Personality Disorder, and Dependent Personality Disorder.

I do not know the original author of the “SAD FACES + GWV” mnemonic.