Key Points
����The clinician should maintain a confidential relationship with the child
or adolescent while developing collaborative relationships with parents,
medical providers, other mental health professionals, and appropriate
school personnel (MS).
����Children with risk factors associated with development of depressive
disorders should have access to early services interventions (CG).
����The information included in this parameter pertains mainly to major
depressive disorder (MDD). There are few clinical studies and no controlled
trials for the treatment of dysthmic disorder (DD) in youths. However, based
on the limited adult literature, efficacious treatments for MDD may also be
useful for the management of DD.
Definitions
����The term ���depression��� in this practice parameter is consistent with the
DSM-IV-TR and encompasses both MDD and DD.
����To be diagnosed with MDD, a child or adolescent must have at least two
weeks of persistent change in mood manifested by either depressed or
irritable mood and/or loss of interest and pleasure, plus a group of other
symptoms including:
>> Wishing to be dead
>> Suicidal ideation or attempts
>> Increased or decreased appetite, weight, or sleep
>> Exaggerated guilt
>> Decreased activity, concentration, energy or self-worth.
����Children are more likely than adults to have:
>> Mood lability
>> Irritability
>> Low frustration tolerance
>> Temper tantrums
>> Somatic complaints
>> Social withdrawal instead of verbalizing feelings of depression.
����By contrast, children tend to have fewer melancholic symptoms, delusions
and suicide attempts than depressed adults.
����These symptoms must represent a change from previous functioning
and produce impairment in relationships or in performance of activities.
Furthermore, symptoms must not be attributable to substance abuse,
medications, other psychiatric illness, bereavement, or medical illness.
