Depression in childhood and adolescence
[12] In an attempt to explain these findings, one theory asserts that preadolescent women on average have more risk factors for depression when compared to men.
[17] In the 1990s, the National Institute of Mental Health (NIMH) found that up to 7% of adolescents who develop major depressive disorder may commit suicide as young adults.
Beyond other clinical disorders, there is also an association between depression in childhood, poor psychosocial and academic outcomes, as well as a higher risk for substance abuse and suicide.
Academic pressure, intrapersonal and interpersonal difficulties, death of loved ones, illnesses, and loss of relationships, have shown to be significant stressors in young people.
[33] While it is a normal part of development in adolescence to experience distressing and disabling emotions, there is an increasing incidence of mental illness globally.
If these symptoms are present for a period of two weeks or longer, it is safe to make the assumption that the child, or anybody else for that matter, is falling into major depression.
[36] In early 2016, the USPSTF released an updated recommendation for the screening of adolescents ages 12 to 18 years for major depressive disorder (MDD).
Research has shown that when a child's age is younger at diagnosis, typically there will be a more noticeable difference in the expression of symptoms from the classic signs in adult depression.
[1][20] For children and adolescents with moderate-to-severe depressive disorder, fluoxetine seems to be best treatment (either with or without cognitive behavioural therapy) but more research is needed to be certain.
While much research is still needed to confirm this treatment program's efficacy, one study showed it to be effective in children with mild or moderate depressive symptoms.
[47] Effective psychotherapy for children always includes parent involvement, teaching skills that are practiced at home or at school, and measures of progress that are tracked over time.
During cognitive behavioral therapy, children and adolescents with depression work with therapists to learn about their diagnosis, how to identify and reshape negative thought patterns, and how to increase engagement in enjoyable activities.
In routine clinical practice, duration varies depending on patient comorbidity, defined treatment goals, and the specific conditions of the health care system.
Therapists can help families improve the way they relate and thus enhance their own capacity to deal with the content of their problems by focusing on the process of their discussions.
[20][55] For children and adolescents with moderate-to-severe depressive disorder, fluoxetine seems to be the best treatment (either with or without cognitive behavioural therapy) but more research is needed to be certain.
Some possible adverse reactions of SSRIs include headache, gastrointestinal side effects, dry mouth, sedation or insomnia and activation.
[20] Activation refers to a state of psychomotor agitation that includes symptoms of insomnia, disinhibition and restlessness that may result in discontinuation of a medication.
[20] Early or premature discontinuation of medications, prior to 6 to 12 months of having achieved remission, is associated with an increased risk of relapse of the depression.
[20] Other medications can be added to SSRIs if a partial response is achieved and further improvement is needed; these agents include lithium, bupropion and atypical antipsychotics.
With the advent of selective serotonin re-uptake inhibitors (SSRIs), child and adolescent psychiatrists began prescribing more anti-depressants in the comorbid conduct disorder/major depressive group because of there was, and is, not a significant correlation of adverse response at higher doses.
[66] Throughout the development and research of this disorder, controversies have emerged over the legitimacy of depression in childhood and adolescence as a diagnosis, the proper measurement and validity of scales to diagnose, and the safety of particular treatments.
This controversy stems from the debate regarding the definition of the specific criteria for a clinically significant depressed mood in relation to the cognitive and behavioral symptoms.
Some psychologists argue that the effects of mood disorders in children and adolescents, or rather the few that exist but do not fully meet the criteria for depression, do not have severe enough risks.
In order to diagnose a child with depression, different screening measures and reports have been developed to help clinicians make a proper decision.
[68] Due to absence of strong evidence that screening children and adolescents for depression leads to improved mental health outcomes, it has been questioned whether it causes more harm than benefit.
Although literature has documented strong psychometric properties, other studies have shown a poor specificity at the top end of scales, resulting in most children with high scores not meeting the diagnostic criteria for depression.
[70] Since then, the United States Food and Drug Administration (FDA) has issued a warning describing the increased risk of adverse effects of antidepressants used as treatment in those under the age of 18.
[72] Due to the variability of these studies, it is currently recommended that if antidepressants are chosen as a method of treatment for children or adolescents, the clinician monitor closely for adverse symptoms, since there is still no definitive answer on why they are depressed.
[73][74] Among the suggested possible reasons why GPs are not following the guidelines are the difficulties of accessing talking therapies, long waiting lists and the urgency of treatment.
[73][75] According to some researchers, strict adherence to treatment guidelines would limit access to effective medication for young people with mental health problems.
