Definitions
����DD consists of a persistent, long-term change in mood that generally is
less intense but more chronic than in MDD. As a consequence, DD is often
overlooked or misdiagnosed. Although the symptoms of dysthymia are not
as severe as in MDD, they cause as much or more psychosocial impairment.
For a DSM-IV diagnosis of DD, a child must have depressed mood or
irritability on most days for most of the day for a period of 1 year, as well as
two other symptoms from a group including:
>> Changes in appetite or weight and changes in sleep
>> Problems with decision-making or concentration
>> Low self-esteem, energy, and hope.
����There are no biological or imaging tests clinically available for the diagnosis
of depression.
Assessment
Screening
����The psychiatric assessment of children and adolescents should routinely
include screening questions about depressive symptomatology (MS).
����If the screening indicates significant depressive symptomatology, the
clinician should perform a thorough evaluation to determine the presence of
depressive and other comorbid psychiatric and medical disorders (MS).
Evaluation
����The evaluation must include assessment for the presence of harm to self
or others (MS).
����The evaluation should assess for the presence of ongoing or past exposure
to negative events, the environment in which depression is developing,
support, and family psychiatric history (MS).
Drug Table
Current FDA-approved SSRIs for adults and adolescents with major
depressive disorder
Agent (Brand)
Indication
Escitalopram
Lexapro��
Major Depressive Disorder in adults and in adolescents
12 to 17 years of age
Fluoxetine
Prozac��
Major Depressive Disorder in adult patients and in pediatric
patients aged 8 to 18 years
