Depression in children

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 10 Feb 2026

最后更新： 19 Feb 2026

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. Depression may be chronic or recurring, is a leading cause of disability among children, and can lead to death by suicide.

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. Suicidality needs to be assessed at each healthcare encounter.

Treatment is typically with active monitoring, specific psychotherapies, antidepressants, or a combination of these therapies.

Following recovery, relapse or recurrence rate is high in the absence of continuation treatment.

定义

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/drug-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, and unspecified depressive disorder.[1] This topic focuses on MDD and persistent depressive disorder. MDD in children is typically more severe than persistent 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 chronic form of depressive disorder, which is characterized by a sad or irritable mood, lasting for at least 1 year, with 2 or more additional depressive symptoms.

病史和体格检查

关键诊断因素

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

完整详情

其他诊断因素

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

完整详情

危险因素

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 drugs (e.g., corticosteroids, interferon)
substance use problems/disorders
sedentary behavior
screen time

完整详情

诊断性检查

首要检查

clinical diagnosis

完整详情

需考虑的检查

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

完整详情

治疗流程

初步治疗

at risk of suicidality

急症处理

mild

moderate or severe

持续性治疗

following stabilization of acute symptoms

撰稿人

作者

Philip Hazell, BMedSc, MBChB, PhD, FRANZCP, Cert Accred Child Psychiatry (RANZCP)

Honorary Professor

Specialty of Psychiatry, School of Medicine

The University of Sydney

Sydney

Australia

Clinical Professor

School of Medicine, Faculty of Health

Charles Darwin University

Darwin

Australia

利益声明

PH declares that he has no competing interests.

Khrista Boylan, MD, PhD, FRCPC

Associate Professor

Psychiatry and Behavioural Neurosciences

McMaster University

Hamilton

Canada

利益声明

KB declares that she has no competing interests.

鸣谢

Professor Philip Hazell and Dr Khrista Boylan would like to gratefully acknowledge Dr Lisa Pan, Dr David A. Brent, Dr Rongrong Tao, Dr Graham Emslie, and Dr Taryn Mayes, the previous contributors to this topic.

利益声明

LP declares that she has no competing interests. 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. 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.

同行评议者

Shannon Barnett, MD, MBE

Assistant Professor of Psychiatry and Behavioral Sciences

The Johns Hopkins University School of Medicine

Baltimore

Раскрытие информации

SB declares that she has no competing interests.

Richa Bhatia, MD

Director of Psychiatry

Santa Rosa Community Health

Раскрытие информации

RB declares that he has no competing interests.

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

London

Раскрытие информации

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

New Haven

Раскрытие информации

PJvW declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Zuckerbrot RA, Cheung A, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018 Mar;141(3):e20174081.Полный текст Аннотация

Hua LL, Lee J, Rahmandar MH, et al. Suicide and suicide risk in adolescents. Pediatrics. 2024 Jan 1;153(1):e2023064800.Полный текст Аннотация

Walter HJ, Abright AR, Bukstein OG, et al. Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders. J Am Acad Child Adolesc Psychiatry. 21Oct 2022 [Epub ahead of print].Полный текст Аннотация

National Institute for Health and Care Excellence. Depression in children and young people: identification and management. Jun 2019 [internet publication].Полный текст

Cheung AH, Zuckerbrot RA, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics. 2018 Mar;141(3):e20174082.Полный текст Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Depression in children

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

at risk of suicidality

mild

moderate or severe

following stabilization of acute symptoms

撰稿人

作者

Philip Hazell, BMedSc, MBChB, PhD, FRANZCP, Cert Accred Child Psychiatry (RANZCP)

利益声明

Khrista Boylan, MD, PhD, FRCPC

利益声明

鸣谢

利益声明

同行评议者

Shannon Barnett, MD, MBE

Раскрытие информации

Richa Bhatia, MD

Раскрытие информации

Paramala J. Santosh, MBBS, DipNB (Psych), MRCPsych, MD

Раскрытие информации

Pieter Joost van Wattum, MD, MA

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice