Diagnostic Considerations

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) diagnostic criteria for depressive disorders are the same for children and adolescents as for adults.^[1]

Major depressive disorder (MDD) is diagnosed when the required DSM-5-TR 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.

It is important to be alert to changes in the patient that might signify a switch from a depressive state to a manic state. The risk for bipolar disorder in prepubertal-onset depression is estimated to be between 10% and 20%.^[2]

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. Consideration should be given to 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.

Health-risk behaviors such as smoking, marijuana use, early sexual debut, and hard drug use begin earlier in adolescents who have greater depressive symptoms when compared with their peers. Intervention and instituting treatment programs during early adolescence may help to prevent these risk behaviors later in adolescence.^[41]

Other conditions to be considered include medication reaction, substance abuse, and organic disease presenting as depressive disorder.

Differential Diagnoses

Pediatric Attention Deficit Hyperactivity Disorder (ADHD)
Pediatric Bipolar Affective Disorder
Pediatric Persistent Depressive Disorder (Dysthymia)
Pediatric Generalized Anxiety Disorder
Posttraumatic Stress Disorder

Workup

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Author

Spencer E Black, MD Associate Professor, Department of Pediatrics, Division of Pediatric Behavioral Medicine, Primary Children's Hospital, University of Utah School of Medicine

Spencer E Black, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Tami D Benton, MD Clinical Director, Child and Adolescent Psychiatry, Psychiatrist-in-Chief, Executive Director, Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia

Tami D Benton, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Angelo P Giardino, MD, PhD, MPH, FAAP Wilma T Gibson Presidential Professor and Chair, Department of Pediatrics, University of Utah School of Medicine; Chief Medical Officer, Intermountain Primary Children's Hospital

Angelo P Giardino, MD, PhD, MPH, FAAP is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, International Society for the Prevention of Child Abuse and Neglect, Ray E Helfer Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen 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, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Jacqueline Lynch, MSW, Research Assistant, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.