Characterized by sad or irritable mood, anhedonia, decreased capacity to have fun, decreased self-esteem, sleep disturbance, social withdrawal or impaired social relationships, and impaired school performance.
One of the most common pediatric psychiatric disorders, especially among girls during adolescence.
At-risk children should be screened for depression. It is crucial to make an accurate diagnosis, based on a comprehensive assessment and review of the history, with input from multiple sources.
The safety of the child and others, and the duration and severity of depression, need to be evaluated carefully to help determine the appropriate level of care and treatment modality. Treatment is typically with active monitoring, specific psychotherapies, antidepressants, or a combination of these therapies.
There is an increased risk for substance abuse, suicide attempts, and completed suicide. Suicidality needs to be assessed at each healthcare encounter.
Following recovery, relapse or recurrence rate is high in the absence of continuation treatment.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorizes depressive disorders in children into the following categories: major depressive disorder (MDD), persistent depressive disorder (dysthymia), disruptive mood dysregulation disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder. This topic focuses on MDD and persistent depressive disorder (dysthymia). MDD in children is a more severe form of depressive disorder, and is characterized by at least 5 depressive symptoms, with 3 levels of severity: mild, moderate, and severe. Persistent depressive disorder is a more chronic form of depressive disorder, which is characterized by a chronic sad or irritable mood, lasting for at least 1 year, with 2 or more additional depressive symptoms.
History and exam
- decreased concentration or indecision
- insomnia or hypersomnia
- change of appetite or weight
- excessive fatigue
- feelings of worthlessness or excessive guilt
- feelings of hopelessness
- psychomotor agitation or retardation
- somatic complaints
- social withdrawal or change of friends
- recurrent thoughts of death or suicidal ideation
- increased substance use
- positive family history of depression
- other parental psychopathology
- personal history of other psychiatric disorders (e.g., anxiety)
- stress or trauma
- female sex
- sexual minority status
- personal history of chronic medical illness
- postpartum status
- neighborhood and social instability
- immunosuppressive medications (e.g., corticosteroids, interferon)
- substance use/abuse
Lisa Pan, MD
Assistant Professor of Psychiatry and Clinical and Translational Science
University of Pittsburgh
Services for Teens at Risk
LP declares that she has no competing interests.
David A. Brent, MD
Endowed Chair in Suicide Studies
Professor of Psychiatry, Pediatrics, Epidemiology, and Clinical and Translational Science
University of Pittsburgh
DAB receives royalties from Guilford Press; has received or will receive royalties from the electronic self-rated version of the C-SSRS from ERT, Inc; is on the editorial board of UpToDate; is a reviewer for Healthwise; and is on the board of the Klingenstein Foundation.
Dr Lisa Pan and Dr David A. Brent would like to gratefully acknowledge Dr Rongrong Tao, Dr Graham Emslie, and Dr Taryn Mayes, the previous contributors to this topic. RT is an author of a number of references cited in this topic. GE has received research funds from BioMarin, Eli Lilly, Forest Laboratories, GlaxoSmithKline, and Somerset; has served as a consultant for Biobehavioral Diagnostic Company, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, INC Research Inc., Lundbeck, Pfizer Inc., Seaside Therapeutics, Shire Pharmaceuticals, Valeant, Validus Pharmaceuticals, and Wyeth Ayerst; and has been on the speaker's bureau for Forest Laboratories. TM is an author of a number of references cited in this topic.
Paramala J. Santosh, MBBS, DipNB (Psych), MRCPsych, MD
Honorary Senior Lecturer
Institute of Child Health and Institute of Psychiatry
Consultant in Child and Adolescent Neuropsychiatry and Psychopharmacology
Head of Centre for Interventional Paediatric Psychopharmacology
Department of Child & Adolescent Mental Health
Great Ormond Street Hospital for Children
PJS declares that he has no competing interests.
Pieter Joost van Wattum, MD, MA
Assistant Clinical Professor of Child Psychiatry
Yale School of Medicine
Medical Director of Psychiatry
Clifford W. Beers Guidance Clinic
PJvW declares that he has no competing interests.
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