Although some open studies reported an improvement rate of 60 to 80 percent in children with major depressive disorder, subsequent randomized controlled trials, which accounted for the high placebo effect, have shown equivocal results. Tricyclic antidepressants ( Table 4) were the first available pharmacotherapy for depression in children. The symptoms overall cause clinically significant distress or impairment in social, occupational or other important areas of functioning. The symptoms are not better accounted for by schizoaffective disorder, delusional disorder, schizophrenia or psychotic disorder. There have never been any manic or mixed episodes. Presence or history of one major depressive episode + one hypomanic episode (similar to manic episode but only needs to last four days and is not severe enough to cause marked impairment in function). Medication (lithium, anti-convulsants, psychiatric consultation), psychotherapyīipolar II disorder, recurrent major depressive episodes with hypomanic episodes The mood episodes are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or a psychotic disorder not otherwise specified. The patient is currently in a major depressive episode with a history of one manic or mixed episode. These symptoms are less severe than those in a major depressive disorder but are more persistent.īipolar I disorder, most recent episode depressed Poor concentration/difficulty making decisions Recurrent thoughts of death and suicidal ideationĭepressed/irritable mood for most of the day, for more days than not (by subjective account or observation by others) for one year, including the presence of two of the following symptoms: A depressed/irritable mood or diminished interest/pleasure must be among these criteria and must represent a change from previous functioning: Significant distress or impairment manifested by 5 to 9 of the criteria listed below occurring almost daily for two weeks. Acute episodes last for less than six months, and chronic episodes last six months. Once the stressor (or its consequences) has terminated, the symptoms resolve within six months. Symptoms include depressed mood, tearfulness and hopelessness, and occur in excess of what would usually be expected from exposure to the stressor and cause significant impairment in social and occupational/academic functioning. Bereavement lasting for more than two months may also qualify.ĭevelopment of emotional or behavioral symptoms in response to an identifiable stressor which occur within three months of the stressor. The symptoms are more than transient and do have a mild impact on functioning. However, these behaviors lack the severity to qualify for a depressive disorder. Sadness or irritability that begins to resemble major depressive disorders in a milder form (see criteria for major depressive disorder). (These responses do not include guilt about things other than actions taken or not taken by the survivor at the time of death.) Thoughts of death and morbid preoccupation with worthlessness are also present. Sadness is related to a major loss that typically persists for less than two months after the loss. Transient, normal depressive responses or mood changes to stress. MS SYMPTOMS CHECKLIST FEMALE PROFESSIONALBecause the risk of school failure and suicide is quite high in depressed children and adolescents, prompt referral or close collaboration with a mental health professional is often necessary. The latter agents are better tolerated but not necessarily more efficacious. Tricyclic antidepressants and selective serotonin reuptake inhibitors are medical therapies that have been studied on a limited basis. Psychotherapy appears to be useful in most children and adolescents with mild to moderate depression. Evidence-based treatment guidelines from the literature are limited. A structured clinical interview and various rating scales such as the Pediatric Symptom Checklist are helpful in determining whether a child or adolescent is depressed. Evaluation should include a complete medical assessment to rule out underlying medical causes. Risk factors include a family history of depression and poor school performance. The clinical spectrum of the disease can range from simple sadness to a major depressive or bipolar disorder. It affects 2 percent of prepubertal children and 5 to 8 percent of adolescents. Depression among children and adolescents is common but frequently unrecognized.
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