pediatrics
Depressive Disorders in Children and Adolescents
Symptoms and Signs
Basic manifestations of depressive disorders in children and adolescents are similar to those in adults but are related to typical concerns of children, such as schoolwork and play. Children may be unable to explain inner feelings or moods. Depression should be considered when previously well-performing children do poorly in school, withdraw from society, or commit delinquent acts. In some children with a depressive disorder, the predominant mood is irritability rather than sadness (an important difference between childhood and adult forms). The irritability associated with childhood depression may manifest as overactivity and aggressive, antisocial behavior. In children with intellectual disability, depressive or other mood disorders may manifest as somatic symptoms and behavioral disturbances. Disruptive mood dysregulation disorder involves persistent irritability and frequent episodes of behavior that is very out of control, with onset at age 6 to 10 years. Many children also have other disorders, particularly Oppositional Defiant Disorder (ODD) , Manifestations include the presence of the following for≥12 months (with no period of≥3 months without all of them): Severe recurrent temper outbursts (eg, verbal rage and/or physical aggression toward people or property) that are grossly out of proportion to the situation and that occur≥3 times/week on average Temper outbursts that are inconsistent with developmental level An irritable, angry mood present every day for most of the day and observed by others (eg, parents, teachers, peers) The outbursts and angry mood must occur in 2 of 3 settings (at home or school, with peers). Major depressive disorder is a discrete depressive episode lasting≥2 weeks. It occurs in as many as 2% of children and 5% of adolescents. Major depressive disorder can first occur at any age but is more common after puberty. Untreated, major depression may remit in 6 to 12 months. Risk of recurrence is higher in patients who have severe episodes, who are younger, or who have had multiple episodes. Persistence of even mild depressive symptoms during remission is a strong predictor of recurrence. For diagnosis,≥1 of the following must be present for most of the day nearly every day during the same 2-week period: Feeling sad or being observed by others to be sad (eg, tearful) or irritable Loss of interest or pleasure in almost all activities (often expressed as profound boredom) In addition,≥4 of the following must be present: Decrease in weight (in children, failure to make the expected weight gain) or decrease or increase in appetite Insomnia or hypersomnia Psychomotor agitation or retardation observed by others (not self-reported) Fatigue or loss of energy Decreased ability to think, concentrate, and make choices Recurrent thoughts of death (not just fear of dying) and/or suicidal ideation or plans Feelings of worthlessness (ie, feeling rejected and unloved) or excessive or inappropriate guilt Major depression in adolescents is a risk factor for academic failure, Overview of Substance Use , and Dysthymia is a persistent depressed or irritable mood that lasts for most of the day for more days than not for≥1 year plus≥2 of the following: Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration Feelings of hopelessness Symptoms may be more or less intense than those of a major depressive disorder. A major depressive episode may occur before the onset or during the first year (ie, before the duration criterion is met for persistent depressive disorder). 