Summary
Definition
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
- increased substance use
Risk factors
- 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
Diagnostic investigations
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
Treatment algorithm
Contributors
Authors
Assistant Professor of Psychiatry and Clinical and Translational Science
University of Pittsburgh
Attending Physician
Services for Teens at Risk
Pittsburgh
PA
Disclosures
LP declares that she has no competing interests.
Endowed Chair in Suicide Studies
Professor of Psychiatry, Pediatrics, Epidemiology, and Clinical and Translational Science
University of Pittsburgh
PA
Disclosures
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.
Peer reviewers
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
UK
Disclosures
PJS declares that he has no competing interests.
Assistant Clinical Professor of Child Psychiatry
Yale School of Medicine
Medical Director of Psychiatry
Clifford W. Beers Guidance Clinic
New Haven
CT
Disclosures
PJvW declares that he has no competing interests.
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