Major depressive disorder (MDD) is a major public health concern. Preadolescent onset depression can be severe and can lead to serious consequences. MDD often has onsetearly in life and frequently follows a recurrent course. MDD though not so common in children, its presentation may be atypical leading to underdiagnosis and undertreatment. The diagnosis and management of childhood-onset depression poses a lot of challenge due to different and atypical presentations in children. We report a case of an 8- year - old boy, with the diagnosis of MDD, recurrent episode, severe, full remission, with atypical features by using DSM-5 criteria after repeated mental state examinations, rating scale, exploring history from parents, family members and observation in the ward. There was a significant improvement in his illness following three weeks of treatment with fluoxetine, lithium and supportive psychotherapy.