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Low mood and depression in adolescence: clinical update.

Low mood (dysthymia) in adolescence (11–19-years-old) is common. Estimates for depressive disorders from UK community-based surveys suggest 10–14% of adolescents have a mental health problem that impacts on function; with anxiety and depression being the leading conditions.1 Prevalence of a diagnosed depressive disorder is reported to lie between 1–6%.2

The term ‘depression’, used both as a diagnostic category and also as a subjective description of mood, can be considered to cluster around changes in mood, thinking, and activity levels.

Estimates of recovery suggest 10% of children and young people with depression improve spontaneously within 3 months but the condition is often both recurrent and persistent with 50% still depressed 12 months later.3 Gender differences post-puberty result in more young women reporting low mood, with young people living in disadvantaged households experiencing higher general psychological morbidity.

Low mood in teenagers often presents with irritability and disruptive behavioural disorders, such as school refusal or offending behaviour, that may in turn be associated with substance abuse or a history of sexual abuse (see Box 1). Anxiety is a common comorbid state and present, if looked for, in almost all cases of behavioural disturbances.3 Primary care presentations of low mood may well present as ‘unexplained physical symptoms (not unlike the adult population); musculoskeletal problems …