Depression

Encyclopedia of Childhood and Adolescence, Apr 06, 2001 by Boris Birmaher, M.D. and David Axelson, M.D. Department of Psychiatry University of Pittsburgh School of Medicine Western Psychiatric Institute and Clinic

Children and adolescents with clinical depressions are at high risk for suicide, homicide, abuse of alcohol/drugs, physical illnesses, poor academic and psychosocial functioning. Moreover, after remission, previously depressed children may continue to show significant problems. These psychosocial problems tend to improve with time unless the depression develops again. The existence of other psychiatric disorders, family problems, and environmental stresses influences the risk for recurrent depression and suicide attempts.

Several factors are associated with the onset, duration, and recurrence of early onset MDD. Studies assessing relatives of depressed children and children of depressed parents have concluded that clinical depression runs in families. Investigations of twins who have been raised in separate families and other adoption studies have provided evidence that genetic factors predispose a person to develop clinical depression. Environmental factors such as exposure to negative events (e.g., deaths, divorce , medical illnesses), lack of support, family conflict, and aversive experiences in early childhood (neglect, death, abuse) may also contribute to the development of depression.

Several biological abnormalities, including changes in the secretion of the growth hormone and cortisol, have been linked to children and adolescents with depression. However there are no laboratory tests that diagnose MDD or dysthymic disorder. The most useful tools in diagnosing depression are (1) a thorough evaluation of depressive symptoms through interviews and observation of the child, and (2) interviews with parents and other key figures, such as teachers.

Several treatment strategies, including different forms of psychotherapy and medication, have been developed for the treatment of MDD and dysthymic disorder in adults. Unfortunately, there has been relatively little research conducted with children and adolescents.

Several types of psychotherapies have been used to treat MDD and dysthymic disorder in children and adolescents, including: psychodynamic psychotherapy, cognitive-behavioral therapy (CBT), family therapy , interpersonal therapy (IPT), social skills training, and group therapy. Though the manner of performing the different types of psychotherapy may vary, the overall goal of these therapies is to reduce the symptoms of depression. In addition, they generally try to improve the child's coping skills, problem-solving abilities, academic functioning, parent-child and peer relationships, and, at times, understanding of internal psychological processes. Cognitive-behavior therapy has been the most frequently studied psychotherapy in childhood and adolescent depression; it appears to be effective in the treatment of acute depression, prevention of relapses, and prevention of the onset of new depressions. However, studies of other forms of psychotherapy (IPT, family therapy, social skills training, group therapy) have shown that these forms of therapy are potentially effective as well in treating childhood depression.