pediatrics
Depressive Disorders in Children and Adolescents
Key Points
In children, depressive disorders may manifest as sadness or irritability. Major depressive disorder involves feeling sad or irritable or losing interest or pleasure in almost all activities for most of the day nearly every day during a 2-week period plus other specific symptoms. Diagnose a depressive disorder based on specific clinical criteria, and do appropriate laboratory tests to exclude other disorders (eg, infectious mononucleosis, thyroid disorders, illicit drug use). Involve the family and school while treating the child to enhance the child's continued functioning and provide appropriate educational accommodations. For adolescents (as for adults), a combination of psychotherapy and antidepressants usually greatly outperforms either modality used alone; in younger children, most clinicians opt for psychotherapy although if needed, medications can be used (depending on the child's age). In 2004, the FDA did a meta-analysis that led to a black box warning of an increased risk of suicidal ideation and behavior in children, adolescents, and young adults with all classes of antidepressants; subsequent analyses have cast doubt on this conclusion. 