Approach

Adolescent and pre-adolescent depressive disorders are clinical diagnoses, based on a comprehensive diagnostic evaluation of history and presenting symptoms. It is crucial to make an accurate diagnosis, with input from multiple sources including, but not limited to, the child, parents, and school (teachers, counsellors).

Initial concerns about symptoms and signs may be brought to the attention of the physician by the parents, other carers, or by the child or adolescent themselves. Alternatively, the diagnosis may be made following screening. Children and adolescents with risk factors for depressive illness who are seen at primary care settings need to be screened for depressive disorder. Annual universal screening in a primary care setting is recommended for all children aged 12 years and older, even in the absence of specific risk factors, according to US-based guidance.[57] Children who come to a psychiatric facility always need to be screened for depression, because depression is highly comorbid with other psychiatric disorders.

There is no specific test for childhood depression. Hypothyroidism, anaemia, autoimmune diseases, vitamin deficiencies, and infectious mononucleosis could cause symptoms of depression. Depression risk is also increased in inflammatory bowel disease, asthma, and epilepsy, and with use of medications that are depressogenic, including corticosteroids. A baseline full blood count (FBC) with differential and thyroid function test should be performed to exclude medical causes of depression, particularly if other symptoms of these disorders are present, or if the child is at risk for these disorders.

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