Diagnosis and treatment of depression in children and adolescents is a major challenge. Many children as well as adolescents suffer from depression, a disorder that can have far reaching effects on the functioning and adjustment of young people. Among both children and adolescents, depressive disorders confer an increased risk for illness and interpersonal and psychosocial difficulties that persist long after the depressive episode is over; in adolescents there is also an increased risk for substance abuse and suicidal behavior.
Unfortunately, major depressive disorder-also known as unipolar depression-often goes undiagnosed. Studies show that signs of major depressive disorder in young people are frequently viewed as normal mood swings typical of a particular developmental stage. In addition, health care professionals may be reluctant to prematurely "label" a young person with a mental illness diagnosis. Yet early diagnosis and treatment are important; between 80 and 90 percent of people with depression-even the most serious forms-can be helped.
The scientific literature on treatment of children and adolescents with depression is far less extensive than that concerning adults. A handful of large-scale studies-mostly conducted in the last four to five years-has evaluated the short-term efficacy and safety of treatments for depression in children and adolescents. Larger treatment trials are needed to determine which treatments work best for which youth. Studies are also needed on how to best incorporate these treatments into primary care practice.
Given the challenging nature of the problem, it is usually advisable to involve a child psychiatrist or psychologist in the evaluation, diagnosis, and treatment of a child or adolescent in whom depression is suspected.
This fact sheet, prepared by the National Institute of Mental Health (NIMH), the lead Federal agency for research on mental disorders, summarizes some of the latest scientific findings on child and adolescent depression and lists resources where family physicians can obtain more information.
Scope of the Problem
An NIMH-sponsored epidemiological study of 9- to 17-year-olds estimates that the prevalence of any depression is more than 6 percent, with 4.9 percent having major depression.(1) In addition, research has found that depression onset is occurring earlier in life. A study reported in the Journal of the American Medical Association suggests that early onset depression often persists, recurs, and continues into adulthood.(3) Depression in childhood may also predict more severe illness in adult life.(4) Depression in young people is often accompanied by psychological or somatic symptoms, behavioral manifestations, or other disorders, such as anxiety disorders. It also often occurs in conjunction with illnesses such as diabetes.
