Paeds · mental-behavioural-and-psychosomatic
Depressive disorders in children and adolescents
Also known as Paediatric depression · Adolescent depression · Major depressive disorder in youth · Youth depression · Depressive episode in children
Fellowship guide to depressive disorders in children and adolescents: criteria-based clinical diagnosis, irritability-and-school-failure presentation, suicide-risk assessment, stepped care with CBT or IPT-A and fluoxetine as first-line SSRI, the TADS/TORDIA/ADAPT/IMPACT evidence and Cipriani/Zhou network meta-analyses, the black-box warning used wisely, and ANZ/UK/US guideline differences.
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Target exams
Red flags
- Active suicidal ideation with plan or intent, recent self-harm, or access to lethal means — safety plan, restrict means, and arrange same-day specialist review before any routine prescribing
- A past or current manic or hypomanic episode — screen for bipolar disorder before starting any antidepressant; an SSRI alone can precipitate a mixed or manic switch
- Psychotic features (delusions, hallucinations) or refusal to eat or drink — this is a psychiatric emergency requiring urgent specialist assessment and likely admission
- Rapid worsening, agitation, increased energy with low mood, or behavioural activation soon after an SSRI is started — review the drug and the diagnosis urgently
- Very young (prepubertal) child with a first depressive episode or any developmental regression — look harder for organic, trauma, or safeguarding causes
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Mental and behavioural health
- Depressive disorders in children and adolescents
- Current 2026 PREP curriculum — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Adolescent medicine and mental-health competencies
- Clinical Applications
- Long Cases
- Short Cases
- Communication scenarios
- 4. Professional skills and knowledge: Patient management
- 5. Professional skills and knowledge: Health promotion and illness prevention
- General Paediatrics: Assesses mental-health needs and initiates appropriate management
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Mood and depressive disorders
- Clinical
- History
- Communication
- Child and family mental-health assessment
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics Content Outline — Domain 4: Developmental and Behavioral Pediatrics
- General Pediatrics Content Outline — Domain 15: Mental and Behavioral Health
- General Pediatrics EPA: Assess and manage common mental-health concerns in adolescents
- Patient Care 1: History and Physical Examination
- Patient Care 4: Clinical Reasoning
- Medical Knowledge 1: Clinical Knowledge
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice: coordination with mental-health and school systems
- Medical Expert
- Communicator
- Collaborator
- Pediatrics: Core EPA — Managing common mental-health and behavioural problems
- Pediatrics: Core EPA — Assessing adolescent health and risk behaviours
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]
References15ShowHide
- [1]Cipriani A, Zhou X, Del Giovane C, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet, 2016.PMID 27289172
- [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
- [3]March J, Silva S, Petrycki S, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA, 2004.PMID 15315995
- [4]Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA, 2008.PMID 18314433
- [5]Goodyer I, Dubicka B, Wilkinson P, et al. Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial. BMJ, 2007.PMID 17556431
- [6]Goodyer IM, Reynolds S, Barrett B, et al. Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial. Lancet Psychiatry, 2017.PMID 27914903
- [7]Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA, 2007.PMID 17440145
- [8]Hetrick SE, McKenzie JE, Bailey AP, et al. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev, 2021.PMID 34029378
- [9]Emslie GJ, Heiligenstein JH, Wagner KD, et al. Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry, 2002.PMID 12364842
- [10]Zuckerbrot RA, Cheung AH, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics, 2018.PMID 29483200
- [11]Cheung AH, Zuckerbrot RA, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management. Pediatrics, 2018.PMID 29483201
- [12]Cyranowski JM, Frank E, Young E, Shear MK. Adolescent onset of the gender difference in lifetime rates of major depression: a theoretical model. Arch Gen Psychiatry, 2000.PMID 10632229
- [13]Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry, 2010.PMID 20855043
- [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
- [15]Richardson LP, McCauley E, Grossman DC, et al. Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics, 2010.PMID 21041282