Real depression in children can manifest itself in many ways. Every human being is somewhat different and consequently distress signals and breaking points do not always imitate each other. What remains constant is the internal emotional desert and emptiness. Depression is not just feeling sad or lethargic. Depression is a state in which self-esteem and self-worth are severely impoverished or sometimes completely lost, combined with longstanding and unresolved conflicts built around hostilities which generally tend to be turned inwards. Until recently, children were regarded as having a mental organization not mature enough to experience the quality of depression. Non-depressed children will believe they are worthy of the desired goods, but they are deprived of them; depressed children will feel unworthy of the coveted gratifications. Possible signs of depression include when the child: (1) is extremely self-critical; (2) has an extremely vigilant conscience; (3) needs to be perfect; (4) feels persecuted; (4) is passive, inhibited, and unassertive; or (5) feels lonely and has poor relationships. Motivational factors in suicide include a desire to escape from an emotionally or physically intolerable situation, a hostile gesture, or severe ego disintegration. A disturbance in the early relationships of a child in which the child experiences rejection, may result in a lack of gratification, anger, and feelings of worthlessness. (Four case samples are included.) (ABL)