Depression in children

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 (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.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013. 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.