Key Points
ÎThe 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).
ÎChildren with risk factors associated with development of depressive disorders should have access to early services interventions (CG).
ÎThe 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
ÎThe term "depression" in this practice parameter is consistent with the DSM-IV-TR and encompasses both MDD and DD.
ÎTo 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.
ÎChildren 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.
ÎBy contrast, children tend to have fewer melancholic symptoms, delusions and suicide attempts than depressed adults.
ÎThese 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.
