Pediatrics: Depressive Disorders
The depressive disorders are a group of mental health problems in children and adolescents characterized by a sad or irritable mood. In simple terms, these disorders are caused by a difference in the structure and function of the part of the brain that controls the intensity of sad and irritable moods. Vulnerability to the development of depressive disorders can be genetically determined. Concomitantly, there is often something in the youth’s environment that triggers the sad or irritable feelings, such as poor relationship(s) with peers or with a parent or loss of loved ones. It is estimated that 4 to 5 of 100 youths have depressive disorders.
The most severe of these disorders, major depressive disorder, is characterized by a distinct period of at least 2 weeks during which the child/adolescent experiences a depressed or irritable mood that is present most of the day nearly every day and/or is associated with loss of interest or pleasure in nearly all activities. There are often severe problems with eating, sleeping, energy, concentration, feelings of worthlessness or extreme guilt, and loss of the desire to live. These symptoms may manifest as the youth being cranky, having loss of interest in hanging out with friends, refusal to get out of bed for school in the morning, or preoccupation with song lyrics that suggest life is meaningless. To meet the diagnosis, the problems must cause distress and/or impair the youth’s function at home, at school, or with peers. After puberty, major depressive disorder is more common in girls than boys.
The less severe but longer lasting of these disorders, dysthymic disorder, is characterized by a depressed or irritable mood for most of the day, more days than not, for at least 1 year. There also are problems with eating, sleeping, energy, and concentration, feelings of hope-lessness, and low self-esteem. To meet the diagnosis, the problems must cause distress and/or impair the youth’s function at home, at school, or with peers. Dysthymic disorder occurs equally in boys and girls, and children with this disorder are more likely to develop major depressive disorder in their teenage or early adult years. Diagnosis. Qualified health professionals experienced with children, including child and adolescent psychiatrists, pediatricians, child psychologists, child-trained social workers, counselors, and clinical nurse specialists are best trained and have the most experience to accurately diagnose these depressive disorders. The evaluation typically requires input from multiple people who know the child, and the diagnosis is based upon the findings from interviews of parents/caregivers as well as interviews with the child and a mental status examination. There are no imaging studies, blood tests, or other specific medical testing modalities to diagnose these disorders.
Treatment. Psychotherapy is an effective treatment for these disorders, especially because it particularly helps the youth understand and learn how to cope with sad feelings. These coping strategies include learning how to identify and talk about feelings, how to stop thinking automatic negative thoughts, how to find activities that are soothing and comforting, how to dis- cover and appreciate good things about themselves, and how to build hope for the future. If environmental circumstances are triggering the sad feelings, it is important to change these circumstances, if at all possible, to increase the chance of a successful treatment. If the depressive disorder is severe, for example, if the youth is thinking about wanting to die or has lost most ability to function, then antidepressant medication may be used as a treatment in addition to psychotherapy.
Antidepressant medication may help the youth feel more motivated to work on coping skills in therapy.
Course. The depressive disorders respond well to the above treatments when delivered by qualified mental health professionals. If left untreated, the depressive disorders can lead to death through suicide. This very serious illness also can cause failure in school and involvement in risky behaviors and subsequent difficulties with maintaining or establishing relationships and jobs in adulthood.