Depression in children manifests itself in several ways. One child may become sullen and withdrawn and may experience an overwhelming sense of sadness. Another child might become passive and withdraw from things that used to give him pleasure. He may withdraw from his friends and begin to say disparaging things about himself, feeling that he is stupid or incompetent. Other depressed children manifest it in a diff erent way. Th ey become intense, irritable, and highly reactive with outbursts of anger and negativity. In other cases, youngsters show more variability of mood with fl uctuations between happy and excitable states to sadness or defi ance. Th is latter pattern is sometimes characteristic of children with bipolar depression (Geller & DelBello, 2003; Greenspan & Glovinsky, 2002).