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Depressive disorders in children and adolescents
Last reviewed: 17.10.2021
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Depressive disorders in children and adolescents are characterized by mood changes, including sadness, mood reduction or anxiety, sufficiently pronounced to influence functioning or cause severe depletion. Loss of interests and the ability to have pleasure can be expressed in the same way, and even more than changes in mood. Diagnosis is based on anamnestic data and survey results. Treatment includes the appointment of antidepressants, psychotherapy or a combination of them.
Explicit depressive episodes develop in about 2% of children and 5% of adolescents. The prevalence of other depressive disorders is unknown. The exact cause of depression in children and adolescents is unknown, but it is believed that in adults it is a consequence of the interaction of genetically determined risk factors and external stressors (especially the clash with death at an early age).
[Symptoms of Depressive Disorders in Children and Adolescents
The main manifestations of depression in children are similar to those in adults, but they are associated with typical problems of childhood, such as school and play. Children may not be able to explain their feelings or moods. It is necessary to think about depression if a successful child begins to learn badly, avoids society or commits offenses.
Common symptoms include sadness, excessive irritability, apathy, avoidance of communication, reduced ability to enjoy (often expressed as deep boredom), a feeling that the patient is rejected, disliked, and somatic complaints (eg, headaches, abdominal pains, insomnia), as well as constant self-incrimination. Symptoms may include anorexia, weight loss (or lack of proper weight gain), intermittent sleep (including nightmares), despondency and suicidal thoughts. Excitability in depression in children can manifest as hyperactivity and aggressive, antisocial behavior.
Mood disorders can develop in children with mental retardation, but may manifest somatic symptoms and behavioral disorders.
Diagnosis of depressive disorders in children and adolescents
Diagnosis is based on symptoms and signs. Careful analysis of the anamnesis and appropriate laboratory examination are necessary to exclude drug addiction and diseases, such as infectious mononucleosis and thyroid disease. Anamnesis should be aimed at identifying causal factors such as domestic violence, sexual abuse and exploitation, and the side effects of medications. It is necessary to ask questions that repent of suicidal behavior (for example, thoughts, gestures, attempts).
It is also necessary to bear in mind other mental disorders that can cause mental disorders, including anxiety and bipolar disorder. In some children, who later developed bipolar disorder or schizophrenia, the first symptoms were manifestations of severe depression.
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Prognosis and treatment of depressive disorders in children and adolescents
Severe depression in adolescents is a risk factor for academic failure, abuse of illicit drugs and suicidal behavior. In the absence of treatment, remission may occur after 6-12 months, but relapses often develop. Moreover, during a depressive episode, children and adolescents lag far behind in school, lose important links with friends and peers, and are also at high risk of abusing psychotropic drugs.
Evaluation of the family and social conditions of the child is necessary to identify stress factors that can cause and intensify depression. Appropriate measures aimed at the school and family should accompany the basic treatment in order to ensure appropriate living and learning conditions. Short hospitalization may be necessary for acute episodes, especially with suicidal behavior.
Response to treatment of depression in adolescents, as a rule, corresponds to that in the treatment of adults. According to most studies on the treatment of depression in adults, a combination of psychotherapy and antidepressants significantly exceeds any of the methods used in isolation. With regard to the treatment of depression in children of pre-adolescence, the clarity is much less. Most doctors in young children prefer to conduct a course of psychotherapy, unless the depressive episode is mild or previously psychotherapy was not ineffective. In more severe cases, antidepressants can be an effective adjunct to psychotherapy.
Typically, the drug of first choice is one of the SSRIs, if the use of antidepressants is indicated. Children should be observed in connection with the possibility of developing side effects from behavior, such as dissolution and excitement. Based on the studies conducted in adults, it is suggested that antidepressants acting on both serotonergic and adrenergic / dopaminergic systems may be somewhat more effective; nevertheless such drugs (eg, duloxetine, venlafaxine, mirtazapine, individual tricyclic antidepressants, especially clomipramine) are also prone to cause more side effects. These drugs can be particularly effective in case-resistant cases. Nonserona-thanergic antidepressants, such as bupropion and desiprammin, can also be combined with SSRI to improve efficacy.
As with adults, relapse may develop in children. Children and adolescents should receive treatment for at least 1 year after the symptoms have disappeared. Most specialists now agree that children who have suffered 2 or more severe depressive episodes should receive treatment consistently.