Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- humor triste e/ou irritável
- diminuição do interesse ou incapacidade de sentir prazer
- comprometimento funcional significativo
- ausência de evidências de episódio maníaco ou hipomaníaco
- ausência de história de luto recente
Other diagnostic factors
- diminuição da concentração ou indecisão
- insônia ou hipersonia
- mudanças no apetite ou no peso
- fadiga excessiva
- sentimento de inutilidade ou culpa excessiva
- sentimentos de desesperança
- agitação ou retardo psicomotor
- queixas somáticas
- retração social ou troca de amigos
- pensamentos recorrentes de morte ou ideação suicida e autolesão
- maior uso de substâncias
Risk factors
- história familiar positiva de depressão
- outra psicopatologia parental
- história pessoal de outros transtornos psiquiátricos (por exemplo, ansiedade)
- estresse ou trauma
- sexo feminino
- minoria sexual
- história pessoal de afecção clínica crônica
- estado pós-parto
- vizinhança e instabilidade social
- medicamentos imunossupressores (por exemplo, corticosteroides, interferona)
- problemas/transtornos relacionados ao uso de substâncias
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
Investigations to consider
- hormônio estimulante da tireoide (TSH) sérico e tiroxina livre (T4)
- hemograma completo com diferencial
- exame de urina para detecção de drogas
- teste de gravidez na urina
- B12 e folato séricos
- nível de vitamina D
Treatment algorithm
em risco de probabilidade de suicídio
leve
moderada ou grave
após estabilização dos sintomas agudos
Contributors
Authors
Philip Hazell, BMedSc, MBChB, PhD, FRANZCP, Cert Accred Child Psychiatry (RANZCP)
Conjoint Professor of Child and Adolescent Psychiatry
Specialty of Psychiatry, School of Medicine
University of Sydney
Sydney
Australia
Disclosures
PH declares that he has no competing interests.
Khrista Boylan, MD, PhD, FRCPC
Associate Professor
Psychiatry and Behavioural Neurosciences
McMaster University
Hamilton
Canada
Disclosures
KB declares that she has no competing interests.
Acknowledgements
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.
Disclosures
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.
Peer reviewers
Richa Bhatia, MD
Director of Psychiatry
Santa Rosa Community Health
CA
Disclosures
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
UK
Disclosures
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
CT
Disclosures
PJvW declares that he has no competing interests.
References
Key articles
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.Full text Abstract
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].Full text Abstract
National Institute for Health and Care Excellence. Depression in children and young people: identification and management. Jun 2019 [internet publication].Full text
Hua LL, Lee J, Rahmandar MH, et al. Suicide and suicide risk in adolescents. Pediatrics. 2024 Jan 1;153(1):e2023064800.Full text Abstract
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.Full text Abstract
Locher C, Koechlin H, Zion SR, et al. Efficacy and safety of selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and placebo for common psychiatric disorders among children and adolescents: a systematic review and meta-analysis. JAMA Psychiatry. 2017 Oct 1;74(10):1011-20.Full text Abstract
Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA. 2008 Feb 27;299(8):901-13.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Transtorno bipolar
- Transtorno de ansiedade
- Transtorno de deficit da atenção com hiperatividade (TDAH)
More DifferentialsGuidelines
- Clinical practice guideline for the assessment and treatment of children and adolescents with major and persistent depressive disorders
- Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement
More GuidelinesPatient information
Depressão em crianças e adolescentes: perguntas para fazer ao seu médico
Depressão em crianças e adolescentes: quais as opções de tratamento?
More Patient information
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