TL;DR
Medically reviewed by Daniel Emina, MD, Amen Clinics.
Why can depression look so different from one child to another, even when both have the same diagnosis?
One child may seem withdrawn and tearful, while another is irritable, restless, or struggling to focus. For parents, this can be confusing and frustrating. If it’s all called “depression,” why doesn’t it look the same?
Emerging research using pediatric depression brain scan technology is helping answer that question. A fascinating study using brain SPECT imaging found meaningful differences in how boys’ and girls’ brains function when they’re depressed.
The differences were specifically in patterns of blood flow and activity across key brain regions. These findings suggest that depression may not be a one-size-fits-all condition, especially in children and teens.
In this blog, you’ll learn three important things: what the brain scans revealed, how boys’ and girls’ depression patterns differed, and why these differences matter when it comes to choosing the most effective treatment.
A brain scan study shows that boys and girls with depression have wildly different brains. This is why a one-size-fits-all approach to pediatric depression often falls short.
A brain scan isn’t typically used as a standalone tool to diagnose depression, but it can reveal patterns of brain activity associated with mental health conditions.
When combined with a full clinical evaluation, it can provide valuable insight into what’s happening in a child’s brain.
Depression in children and teens is not just a phase, a personality issue, or something they can simply “snap out of.” It is a real medical condition rooted in the brain.
Research shows that depression is associated with measurable biological changes, including differences in how certain brain regions function. This is where brain imaging becomes especially valuable.
At Amen Clinics, brain SPECT imaging has helped identify distinct patterns of activity linked to depression, reinforcing the idea that mental health challenges are brain health issues, not character flaws.
Understanding this can be a powerful shift for families. When you see depression as a brain-based condition, it opens the door to more targeted, compassionate, and effective care for your child.
SPECT (single photon emission computed tomography) is a type of brain imaging that measures blood flow and activity levels in the brain.
Why does that matter? Because blood flow is closely tied to how active different parts of the brain are. Areas with too much or too little activity can influence mood, energy, focus, and emotional regulation, all of which are affected in depression.
By looking at these patterns, SPECT scans provide insight into how a child’s brain is functioning, not just how they appear on the outside. This makes it a valuable tool for understanding the underlying differences in pediatric depression, including why symptoms can vary so widely from one child to another.
While brain scans offer important insights, they are not a standalone diagnostic tool. A thorough evaluation should always include a detailed clinical history, symptom assessment, and other relevant medical information.
That said, adding brain imaging can make a meaningful difference. Research shows that incorporating SPECT imaging into a traditional psychiatric evaluation leads to a change in diagnosis and/or treatment plan in nearly 79 percent of cases.
This highlights how looking at the brain can uncover critical information that might otherwise be missed.
When used as part of a comprehensive whole-body approach, brain imaging helps clinicians move beyond guesswork, supporting more personalized, effective care for children with depression.
The 2023 brain-imaging study using SPECT scans took a closer look at how depression shows up in the brains of children and teens. The findings revealed clear differences in blood flow patterns between boys and girls.
To better understand how depression may differ between boys and girls, researchers analyzed brain SPECT scans from a large pediatric sample. The study included 140 females and 241 males, all diagnosed with depression, with average ages of about 14.5 for girls and 13.8 for boys.
By comparing cerebral blood flow across multiple brain regions, researchers were able to look for meaningful differences in how depression shows up in the brain.
The scans revealed that boys with depression had higher blood flow in several areas of the brain, including:
These regions are involved in functions like coordination, visual processing, sensory integration, and aspects of attention and perception. This suggests that depression in boys may involve different functional patterns than previously assumed.
In contrast, girls with depression showed higher blood flow in a different set of brain regions, including:
These regions are closely tied to emotional processing, mood regulation, motivation, and reactivity. These areas are often associated with internal emotional experience.
| Brain Differences in Boys vs. Girls with Depression | |
|---|---|
| Boys With Depression | Girls With Depression |
| Higher Blood Flow In: | Higher Blood Flow In: |
| Cerebellum | Cingulum |
| Occipital lobes | Vermis (central cerebellum) |
| Parietal lobe | Subcortical areas (deep brain regions) |
| Temporal lobe | |
| What These Areas Do: | What These Areas Do: |
| Coordination & timing | Emotional processing |
| Visual processing | Mood regulation |
| Sensory integration | Motivation & drive |
| Attention & perception | Emotional reactivity |
Importantly, these findings don’t mean that boys and girls have completely different “types” of depression. Rather, they point to distinct patterns of cerebral blood flow within the same diagnosis.
This distinction matters. It suggests that what looks like the same condition on the surface may be driven by different underlying brain processes. And that may help explain why symptoms, coping styles, and even treatment responses can vary from one child to another.
To make sense of these findings, it helps to understand what these brain areas actually do. Each region plays a role in how your child thinks, feels, and responds to the world, so differences in activity can shape how depression shows up in daily life.
Related: 5 Warning Signs of Childhood Depression
The cingulum (or cingulate gyrus) is deeply involved in emotional processing and self-regulation. It helps your child shift attention, manage emotional responses, and adapt to changing situations.
When this area is more active, it may be linked to increased focus on negative thoughts, emotional sensitivity, or difficulty letting go of distressing feelings. This can sometimes show up as rumination, mood swings, or feeling “stuck” emotionally.
Subcortical regions are located deeper in the brain and play a key role in basic emotional responses, motivation, and energy levels.
These areas help regulate how your child reacts to stress, experiences pleasure, and initiates action. Changes in activity here may be associated with low motivation, irritability, emotional reactivity, or a reduced ability to feel enjoyment. These are common features of depression in kids and teens.
The cerebellum is often thought of as the brain’s coordination center, but it also plays an important role in emotional regulation, attention, and cognitive processing. The vermis, a structure within the cerebellum, is particularly involved in mood and emotional balance.
Differences in these areas may influence how a child regulates emotions, processes information, or responds to stress. This helps explain why depression isn’t just about feeling sad. It can also affect focus, behavior, and overall functioning.
These regions are responsible for how your child interprets and interacts with the world around them.
When activity differs in these areas, it may affect how a child perceives situations, focuses attention, or processes experiences. In depression, this could show up as difficulty concentrating, feeling overwhelmed by surroundings, or interpreting events in a more negative way.
Together, these brain regions help explain why depression can look so different from one child to another. And they show why understanding the brain can offer valuable clues for more personalized care.
If you’ve ever wondered why depression can look so different from one child to another, these brain findings offer an important clue. The way depression shows up isn’t just about behavior, it may reflect what’s happening in different parts of the brain.
Related: A Parent’s Guide to Children’s Mental Health
One of the most important takeaways from this research is that the same diagnosis of depression can involve different brain patterns.
Two children may both be diagnosed with depression, yet have very different activity levels in key brain regions. That means their symptoms, challenges, and even what helps them feel better may not be the same.
This is why a one-size-fits-all approach to mental health often falls short. When you understand the brain, you begin to see why individualized care matters so much.
The study also suggests that these brain differences may be related to how boys and girls cope with depressive symptoms.
For example, differences in brain activity tied to emotional processing, reactivity, or attention may influence whether a child tends to internalize distress or express it outwardly.
While every child is unique, these patterns may help explain why some kids withdraw and others become more reactive or behaviorally challenged when they’re struggling.
Because different brain systems may be more involved, depression doesn’t always look the way people expect.
Some children may appear quiet, withdrawn, or low-energy. Others may seem irritable, restless, or easily frustrated. Some may struggle with focus and thinking clearly, while others feel overwhelmed by emotions they can’t easily regulate.
These differences don’t mean one child is “more depressed” than another. They simply reflect different ways the brain is affected.
Understanding this can help parents, caregivers, and clinicians respond with more clarity, compassion, and the right kind of support.
One of the most important questions raised by this research is whether these brain differences could offer a reason why depression treatments don’t work the same way for every child.
The 2023 SPECT study suggests that sex differences in cerebral blood flow may play a role in how individuals respond to treatments, such as antidepressant medications and other therapeutic options.
This supports a broader shift in how we think about depression care. Rather than relying on trial-and-error or one-size-fits-all approaches, understanding the brain may help guide more personalized treatment planning.
At its core, this study reinforces a simple but powerful idea: when you look at the brain, you get better information. And better information can lead to more targeted, effective care.
Research like this can be exciting, but it’s important to understand it in the right context. These findings offer valuable insight into pediatric depression, but they don’t tell the whole story.
Here’s how to think about what this study means:
Taken together, this study adds an important layer of understanding: depression is complex, and looking at the brain can help us better understand that complexity without oversimplifying it.
At Amen Clinics, we view pediatric depression as a brain-based condition. And research like this reinforces that it may affect boys and girls in different ways.
That’s why we focus on understanding the underlying brain patterns driving each child’s symptoms, rather than relying on a standardized approach.
At Amen Clinics, we do psychiatry differently by looking at the brain. Instead of guessing based on symptoms alone, we use objective data to better understand how the brain is functioning.
This approach helps shift the conversation from “what’s wrong with you?” to “what’s going on in your brain?” This can be more accurate, more compassionate, and more effective.
Brain SPECT imaging allows us to see patterns of blood flow and activity associated with different types of depression and other mental health conditions in children and teens.
These patterns can vary widely from one teen to another., which offers a potential reason why symptoms and responses to treatment are not always the same.
When you have better information about how a child’s brain is working, you can create a more targeted and individualized treatment plan.
At Amen Clinics, this brain-based, whole-body approach helps guide care that is tailored to each child’s unique needs. This supports better outcomes and a clearer path forward for families.
Depression in children and teens is often treated as a single condition, but this research suggests it may not be that simple. The 2023 SPECT analysis found that boys and girls with depression can show different patterns of brain activity, including higher cingulate and subcortical activity in girls and higher cerebellar, occipital, parietal, and temporal activity in boys.
These findings don’t change the diagnosis, but they do deepen our understanding of it. When depression involves different brain patterns, it may also require different approaches to care.
The bigger takeaway is this: pediatric depression is not the same for every child. Looking at the brain can help explain why symptoms vary and support a more personalized, brain-based path to healing for every child.
A brain scan can show patterns associated with depression. Research from Amen Clinics shows brain imaging can identify different brain patterns linked to depression.
Yes. In this sample, males showed higher cerebral blood flow in cerebellar, occipital, right parietal, and right temporal regions, while females showed higher blood flow in the cingulum, vermis, and subcortical areas.
No. However, the study suggests these differences may contribute to variations in treatment response. It did not directly test treatment outcomes.
SPECT measures blood flow and activity patterns in the brain, offering insight into how different regions are functioning.
Because different brain patterns may help explain why depression symptoms and responses to treatment can vary across children and teens.
Pediatric depression, anxiety, and other mental health conditions can’t wait. At Amen Clinics, we practice precision medicine—using brain SPECT imaging and comprehensive evaluations to understand what’s really happening in your brain, not just your symptoms. Our whole-body approach to holistic psychiatry combines cutting-edge neuroscience with natural ways to treat mental health conditions, including targeted nutrition, supplements, lifestyle strategies, therapy, and medications (when necessary). Every treatment plan is personalized to address the root causes of your struggles and support the health of your brain, body, and mind. Don’t settle for guesswork. You deserve answers—and a plan built specifically for you. Speak with a Brain Health Advisor today at 888-288-9834 or visit our contact page to get started.
About the Reviewer
Dr. Daniel Emina is an Associate Medical Director at Amen Clinics Orange Country Metro Area and a child, adolescent, and adult psychiatrist. He earned his medical degree from the UCLA School of Medicine and completed his psychiatry residency and child/adolescent psychiatry fellowship at the University of Hawaii Department of Psychiatry. Dr. Emina uses psychotherapy, pharmacotherapy, pharmacogenomics, brain imaging, TMS, and integrative therapies to optimize brain health and function. He is experienced in treating anxiety, depression, ADHD, autism spectrum disorders, OCD, PTSD, addiction, mood disorders, and traumatic brain injuries in both children and adults.
Stafford C, Amen D, Golden C, Willeumier K. A – 128 Sex Differences in a Pediatric Sample of Depression: a SPECT analysis. Arch Clin Neuropsychol. Oct 2023 20;38(7):1300. doi: 10.1093/arclin/acad067.145
Tozzi, L., Zhang, X., Pines, A. et al. Personalized brain circuit scores identify clinically distinct biotypes in depression and anxiety. Nat Med 30, 2076–2087 (2024). https://doi.org/10.1038/s41591-024-03057-9
