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Key Features

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Essentials of Diagnosis
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  • Dysphoric mood, mood lability, irritability, or depressed appearance, persisting for weeks to months at a time

  • Characteristic neurovegetative signs and symptoms (eg, changes in sleep, appetite, concentration, and activity levels)

  • Suicidal ideation, feeling of hopelessness

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General Considerations
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  • Clinical depression can be defined as a persistent state of unhappiness or misery that interferes with pleasure or productivity

  • Incidence of depression in children

    • Increases with age, from 1% to 3% before puberty to around 8% for adolescents

    • Higher when other family members have been affected by depressive disorders

    • Equal between sexes in childhood

    • With the onset of puberty the rates of depression for females begin to exceed those for males by 5:1

  • Lifetime risk of depression ranges from 10% to 25% for women and 5% to 12% for men

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Clinical Findings

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  • Typically, a child or adolescent with depression begins to look unhappy and may make comments such as "I have no friends," "life is boring," "there is nothing I can do to make things better," or "I wish I were dead"

  • Behavior patterns change from baseline and can include social isolation, deterioration in schoolwork, loss of interest in usual activities, anger, and irritability

  • Sleep and appetite patterns commonly change

  • Child may complain of tiredness and nonspecific pain such as headaches or stomach aches

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Diagnosis

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  • The American Academy of Pediatrics recommends annual screening for depression in children age 12 and older using a standardized measure

  • Depression often coexists with other mental illnesses, such as

    • ADHD

    • Oppositional defiant disorder

    • Conduct disorder

    • Anxiety disorders

    • Eating disorders

    • Substance abuse disorders

  • Depressed adolescents should also be screened for hypothyroidism and substance abuse

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Treatment

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Nonpharmacologic
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  • Cognitive-behavioral therapy

    • Improves depressive symptoms

    • Focuses on building coping skills to change negative thought patterns

    • Helps identify, label, and verbalize feelings and misperceptions

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Pharmacologic
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  • Fluoxetine (Prozac)

    • Usual starting dose: 10 mg/d (60 mg max); recommend decrease maximum dosage by around one-third for prepubertal children

    • Increase increment (after about 4 weeks): 10–20 mg; recommend using the lower dose increase increments for younger children

    • FDA approved for depression in children: Yes (> age 8)

    • Long half-life, no side effect from a missed dose

  • Citalopram (Celexa)

    • Usual starting dose:10 mg/d (40 mg max); recommend decrease maximum dosage by around one-third for prepubertal children

    • Increase increment (after about 4 weeks):10–20 mg; recommend using the lower dose increase increments for younger children

    • FDA approved for depression in children: No

    • Few drug interactions

  • Sertraline (Zoloft)

    • Usual starting dose: 25 mg/d (200 mg max); recommend decrease maximum dosage by around one-third for prepubertal children

    • Increase increment (after about 4 weeks):25–50 mg; recommend using the lower dose increase increments for younger children

    • FDA approved for depression in children: No

    • May be prone to side ...

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