Depressive disorders in children and adolescents

Overview & Definition

Picture the fourteen-year-old who used to love football and now will not leave her room, whose marks have slid from A to D in a term, who snaps at everyone and tells no one she has started cutting her thighs. That cluster — mood, function and risk changing together — is what you are looking for, not a single sad mood on a clinic day. [10] [13]

A depressive disorder is a syndromal, impairing disturbance of mood and related cognition, body and function, not ordinary sadness and not a reaction in proportion to a small stressor. In young people the mood may be irritable rather than plainly sad, and the presentation is often carried by school decline, withdrawal, sleep and appetite change, or behaviour change rather than a verbal complaint of low mood. [10] [11]

Diagnosis remains clinical and criteria-based. Rating scales such as the PHQ-9 modified for adolescents (PHQ-A) or the Mood and Feelings Questionnaire support screening, severity grading and tracking — they do not make the diagnosis, and a single high score is never sufficient to start a drug. [15] [10]

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2. [2]Zhou X, Teng T, Zhang Y, et al. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. Lancet Psychiatry, 2020.PMID 32563306
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14. [14]O'Keeffe S, Martin P, Goodyer IM, et al. Prognostic Implications for Adolescents With Depression Who Drop Out of Psychological Treatment During a Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry, 2019.PMID 30946974
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