Definitions
ÎDD 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.
ÎThere are no biological or imaging tests clinically available for the diagnosis of depression.
Assessment Screening
ÎThe psychiatric assessment of children and adolescents should routinely include screening questions about depressive symptomatology (MS).
ÎIf 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
ÎThe evaluation must include assessment for the presence of harm to self or others (MS).
ÎThe 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)
Escitalopram Lexapro®
Fluoxetine Prozac®
Indication
Major Depressive Disorder in adults and in adolescents 12 to 17 years of age
Major Depressive Disorder in adult patients and in pediatric patients aged 8 to 18 years
