eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Depression: Differential Diagnoses & Workup

Author: Tami D Benton, MD, Director of Clinical Services, Program Director, Department of Psychiatry, Children's Hospital of Philadelphia; Assistant Professor, University of Pennsylvania
Contributor Information and Disclosures

Updated: Jul 15, 2009

Differential Diagnoses

Anxiety Disorder: Generalized Anxiety
Attention Deficit Hyperactivity Disorder
Child Abuse & Neglect: Posttraumatic Stress Disorder
Mood Disorder: Bipolar Disorder
Mood Disorder: Dysthymic Disorder

Other Problems to Be Considered

Major depressive disorder is diagnosed when the required DSM-IV symptoms are present and other disorders have been ruled out. Symptom clusters, such as seasonality, atypical symptoms, psychosis, or hypomania, characterize different subtypes of depression. Identify these subtypes because they require different modes of treatment.

In youths, manic and depressive symptoms may be mixed (mixed episode), which is a common presentation of bipolar disorder among youths. Hypomanic symptoms may be quite brief at the onset of bipolar disorder and may be disregarded. Comorbid symptoms of attention deficit hyperactivity disorder (ADHD), anxiety, posttraumatic stress disorder, substance abuse, and sleep disorders are often overlooked and require careful assessment and treatment. Consider the diagnosis and treatment of youths with subclinical depression because these children are at high risk to develop depression, and early intervention may be beneficial.

Other conditions to be considered include the following:

  • Medication reaction or substance abuse
  • Organic disease presenting as depressive disorder

Workup

Laboratory Studies

  • Include a CBC count with differential in the initial laboratory evaluation to rule out infection and anemia.
  • Assay electrolytes, BUN, creatinine clearance, creatinine, and urine osmolality to exclude renal disorders.
  • When using tricyclic antidepressants or lithium carbonate, monitor plasma levels to measure compliance and to avoid toxicity.
  • Evaluate urine osmolality and creatinine clearance periodically during lithium treatment.

Other Tests

  • Consider EEG evaluation for patients with a history or presentation that is suggestive of seizure disorder.
  • Perform ECG prior to treatment with a tricyclic antidepressant.
  • Perform liver function tests and thyroid function tests (triiodothyronine [T3], thyroxine [T4], and thyroid-stimulating hormone [TSH]) to rule out thyroid disease.
  • In 1985, Weller et al report that a properly performed dexamethasone suppression test (DST) can be helpful to confirm a clinical diagnosis of depression and may be useful in monitoring treatment response during follow-up.17 The overall sensitivity of the DST is 70% in prepubertal children and 47% in adolescents.
  • CDI is a simple test that may assist in detecting occurrence and degree of childhood depression.

More on Depression

Overview: Depression
Differential Diagnoses & Workup: Depression
Treatment & Medication: Depression
Follow-up: Depression
References
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Further Reading

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Keywords

major depressive disorder, MDD, manic-depressive disorder, bipolar disorder, suicide, suicidal ideation, childhood depression, serotonin, auditory hallucinations, depressed mood, sleep disturbance, catalepsy, seasonal mood disorder, seasonal affective disorder, attention deficit hyperactivity disorder, ADHD, anxiety, posttraumatic stress disorder

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Contributor Information and Disclosures

Author

Tami D Benton, MD, Director of Clinical Services, Program Director, Department of Psychiatry, Children's Hospital of Philadelphia; Assistant Professor, University of Pennsylvania
Tami D Benton, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Carol Diane Berkowitz, MD, Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center
Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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