Depression in children and adolescents - A guide to diagnosis and treatment

Mood disorders are prevalent and serious disorders in children and adolescents, often causing substantial difficulties in school performance and social relationships. Although the criteria for major depressive disorder are the same for children and adolescents as for adults, some challenges exist in ascertaining the diagnosis. For example, children often have difficulty in expressing or recalling information regarding their disorder; therefore, multiple informants (usually parents) must often be used to obtain the information. In addition, comorbid diagnoses are common in early onset depression, making diagnosis more difficult. However, depression is diagnosable in children and adolescents. The treatment of depression in this population is multi-modal, including the child, parents and school, and is aimed at shortening the episode of depression. Treatment, which is individualised based on need, may include psychotherapy, family therapy or education, and pharmacological treatment. Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are generally the first line of pharmacological treatment in children and adolescents, as they are well tolerated and appear to have fewer adverse effects than antidepressants. As with adults, the majority of children and adolescents with depression do recover within 1 to 2 years; however, recurrence is common. In fact, the recurrence rate is somewhat higher in children and adolescents than in adults. Unfortunately, little research has been done regarding maintenance treatment in children and adolescents. Further research in this area is needed to determine the most effective duration of medication treatment.