Purpose of review Depression in pediatric inflammatory bowel disease (IBD) is increasingly recognized to be a heterogeneous condition with diverse underlying predisposing and precipitating factors. Although there is a growing awareness regarding the benefits of integrating behavioral health into medical care, the way psychiatric treatments can best target different aspects of depression and related dysfunction has not been systematically explored. Recent findings This review discusses neurobiological risk factors for depression in IBD including inflammation, associated anti-inflammatory treatment with corticosteroids, pain, and sleep disturbance, as well as psychosocial factors including reactions to illness, illness perception, and disease and environmental stressors with emphasis of how these factors can influence treatment decisions. Empirically-supported psychosocial and psychopharmacological interventions are discussed within this context. Summary Understanding the diverse pathways that can lead to depression in youth with IBD can lead to the development of more targeted interventions and better integration of psychosocial care into the medical treatment of IBD.