OBJECTIVES: To examine the patterns and associated factors of health care expenditures in the pediatric population with depression using 2005-2006 Medical Expenditure Panel Survey (MEPS) data. METHODS: Analysis was based on a nationally representative sample of children and adolescents aged 5 to 17 years with an ICD-9-CM diagnosis of depression from the 2005-2006 MEPS. Multivariate model within the conceptual framework of Andersen's Behavioral Model was used to examine factors related to healthcare expenditures in children and adolescents with depression. Smearing techniques were used to transform estimated log costs into actual costs. RESULTS: Analysis of annual expenditures in children and adolescents with depression revealed that average total and out-of pocket payments per child with depression were $3963 (95% CI 2453-5471) and $672 (95% CI 377-973), respectively. Prescription-related expenditures in children and adolescents with depression revealed that average total and out-of pocket payments were $1096 (31% of total) and $343 (51% of total), respectively. Multivariate model revealed that predisposing, enabling, and need factors were associated with total health expenditures. Among the predisposing characteristics, age (+$3069) and family history of psychiatric disorders (+$2066) were positively associated with total expenditures. Among the enabling characteristics, children and adolescents having usual source of care provider had lower total expenditures (-$3523) than those without usual source of care. Hyperactivity disorders (+$4001) and functional impairment (+$1304) increased total expenditures in children with depression. CONCLUSIONS: Analysis of MEPS data revealed prescription medications account for significant portion of total and out-of-pocket expenditures. Predisposing, enabling, and need factors play an important role in the overall burden of pediatric depression in the United States.