Symptoms

• Sadness
• Irritability
• Change in appetite
• Change in sleeping patterns (too much or too little)
• ​Loss of interest in activities
• ​Fatigue
• ​Feeling slowed down or "burned out"
• ​Excessive feelings of guilt
• ​Inability to concentrate
• ​Indecisiveness
• Feelings of hopelessness and helplessness
• Recurring thoughts of death and suicide
• Physical complaints (stomachaches, headaches)
• Behavioral changes
• ​Conflicts with family and friends
• ​Decline in school performance
• Inappropriate sexual activity
• ​Use of alcohol or drugs
  

Diagnosis
A good diagnostic evaluation will include the following:

• A complete history of symptoms to determine how long and how often they have been present
• Questions about the thoughts of death or suicide
• Inquiry about any family history of depression and other mental illnesses

Primary care clinicians should evaluate for depression in high-risk adolescents as well as those who present with emotional problems as the chief complaint. Clinicians should assess for depressive symptoms based on diagnostic criteria established in the DSM-IV or ICD 10 and should use standardized depression tools to aid in the assessment.

Treatment
Both psychotherapies and antidepressant medications can be effective in treating childhood and adolescent depression.

 Psychotherapies proven to treat depression effectively in youth:

• Cognitive behavioral therapy
•  Interpersonal therapy

Both are time-limited, structured therapies that are typically administered in either individual or group sessions. Additional options for treatment are listed here.

Psychopharmacology shown to treat depression effectively in youth:

• Selective Serotonin Reuptake Inhibitors (SSRIs) (The most well-known is Fluoxetine)

These medications target a chemical in the brain called serotonin, which is believed to play a minor role in depression. Other therapies such as family therapy, play therapy, and other medication treatments are available but there is little evidence demonstrating their effectiveness.

Remember...

• Review these treatment options with the child and his/her family
• Include the child and his/her family in the treatment plan

View the Case Summary