Symptoms Of Depression In Children And Adolescents

Q: Approximately 1 in 20 children and adolescents suffers from major depression. A smaller number-perhaps 1 in 200-suffers from a bipolar disorder, especially bipolar II and cyclothymia. Preliminary evidence suggests that MDD may be increasing in the pediatric population in a cohort fashion.

A:Follow-up studies in clinical populations suggest that pre-pubertal depression carries a high probability of chronic recurrent depression in up to 70% of cases, and of bipolar disorder in up to 20% of cases. Risk factors for recurrent illness include a positive family history for affective disorder, female gender and psychosocial adversity, including important losses. A positive family history of manic-depressive illness, especially if multi-generational, dramatically increases the risk for bipolarity. Major depression in the pediatric population is readily diagnosable using DSM-IV criteria, i.e. the criteria sets work. Nevertheless, there are clear age-related differences between children, adolescents and adults in depressive symptoms and associated features. For example, adolescents are more likely to complain of feeling sad without looking sad, whereas younger children and adults also look sad when depressed. Irritability also seems to be a much more prominent symptom in pediatric than in adult depression. Excluding somatic symptoms (in smaller children) and sleep rhythm disturbances (in adolescents), vegetative symptoms may be somewhat less common in young persons than in adults. Like other disorders, major depression is commonly comorbid with other internalizing and externalizing disorders. The anxiety disorders often precede MDD, especially in younger children. Subtle anxiety symptoms sometimes remain when depressive symptoms resolve, and may form the nidus for a recurrent depressive episode. Conduct disorder and substance abuse may pose a significant problem in depressed adolescents. Comorbid disruptive behaviors may signal comorbid bipolarity in a substantial number of depressed acting out youth. Conversely,

while ADHD and hypomania overlap symptomaticallyand most if not all children with bipolar disturbances meet DSM criteria for ADHDfew children with ADHD are bipolar. Absent thought disorder symptoms and/or clear mania, our practice is to treat ADHD symptoms first and only then to target residual affective symptoms are representing bipolarity. Finally, learning problemswhether due to failure to acquire skills due to affective illness and/or to comorbid neurocognitive impairmentsare not uncommon in youth with internalizing psychopathology. If impediments to successful learning are not addressed, school-related demoralization will confound the outcome of treatment for MDD.