Depression in children is 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.
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 school disengagement, substance use disorders, 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, text revision (DSM-5-TR) categorizes depressive disorders into the following categories: major depressive disorder (MDD), persistent depressive disorder, 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. 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
Key diagnostic factors
- sad and/or irritable mood
- decreased interest or lack of enjoyment
- significant functional impairment
- no evidence of a manic or hypomanic episode
- no history of recent bereavement
Other diagnostic factors
- 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 and self-harm
- 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/misuse
1st investigations to order
- clinical diagnosis
Investigations to consider
- serum thyroid-stimulating hormone (TSH) and free thyroxine (T4)
- complete blood count with differential
- urine drug screen
- urine pregnancy test
- serum B12 and folate
- vitamin D level
at risk of self-harm
moderate or severe
following stabilization of acute symptoms
- Bipolar disorder
- Anxiety disorder
- Depression in children and young people: identification and management
- Guidelines for adolescent depression in primary care (GLAD-PC): Part II. Treatment and ongoing management
Depression in children and teenagers: what is it?
Depression in children and teenagers: what treatments work?More Patient leaflets
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