Depression

Depression is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • General term that includes major depressive disorder (MDD), persistent depressive disorder (dysthymic disorder), depression associated with bipolar disorder, disruptive mood dysregulation disorder and adjustment disorder with depressed mood
  • Syndrome of persistent sadness or irritability associated with a variety of symptoms, resulting in functional impairment in the following:
    • Interpersonal (family, friends) relationships
    • Health (somatic complaints, unhealthy habits)
    • Work or school (task completion, grades)
    • Safety (high-risk behaviors including suicide)

Epidemiology

  • 12-month prevalence of MDD: 7.5% of adolescents (age 13 to 18 years), 3–4% in younger children
  • Lifetime prevalence: 11% will have diagnosable depression by adolescence.
  • Ratio of females to males: 1:1 in school-aged children, 2:1 in adolescents
  • Often chronic with high rate of recurrence and comorbidity with other psychiatric disorders
  • <45% of affected individuals receive disorder-specific care.

Risk Factors

  • Family history of depression, bipolar disorder, suicidal behavior in 1st-degree relative
  • Personal history of anxiety disorders, ADHD, learning disabilities, and conduct problems
  • Prior depressive episodes
  • Family dysfunction or caregiver–child conflict
  • Negative style of interpreting events and coping with stress
  • Substance abuse
  • Exposure to adversity (e.g., victim of abuse, bullying)
  • Chronic illness (including obesity)
  • Not everyone with exposure to adversity or chronic illness will go on to have MDD (some moderators are resilience and response to treatment).

Commonly Associated Conditions

40–70% of children and adolescents with depression have comorbid psychiatric disorders:

  • Anxiety disorders
  • Somatization disorders
  • Disruptive behavioral disorders (e.g., oppositional defiant and conduct disorders)
  • Eating disorders
  • ADHD
  • Substance abuse
  • Physical or sexual abuse

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