Childhood depression, like depression in adulthood, is a chronic and recurrent illness that causes significant morbidity and mortality. A major depressive episode may remit spontaneously (even without treatment) within 1 to 2 years, but may last up to 9 months in clinical samples.[70] About 50% to 60% of young people respond to first psychotherapy or medication treatment. Between 40% and 50% of young people who do not respond to at least one medication trial respond when switching to a new antidepressant, or switching to a new antidepressant plus psychotherapy.[116] However, once improved, the relapse or recurrence rate is high. Following recovery from a depressive episode, it is estimated that about 40% of young people have a relapse of the index episode, or a recurrence (new episode) of a major depressive episode within 2 years after remission. Up to 70% of young people have a recurrence of an episode within 5 years of remission. Depressed young people spend up to 30% of their lives in a depressive episode, which causes significant impairment in academic and social functioning and increases the risk for suicide and substance abuse.[70] One UK-based cohort study (n=3884) found that the presence of severe affective symptoms in adolescents (both anxiety and depressive symptoms) was associated with an increased risk of premature mortality over a 53-year follow-up period. (In the study, affective symptoms were rated by teachers using a rating scale which pre-dated the introduction of diagnostic criteria.)[163]

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