Approach Considerations

There are no specific laboratory evaluations that identify depression. However, other potential etiologies must be ruled out, guided by clinical presentation. Workup includes laboratory evaluation along with additional, selected tests. Include a complete blood count (CBC) with differential in the initial laboratory evaluation to rule out infection and anemia. Assay electrolytes, blood urea nitrogen, creatinine clearance, creatinine, and urine osmolality to exclude renal disorders.

When using tricyclic antidepressants (TCAs) or lithium carbonate, monitor plasma levels to measure compliance and to avoid toxicity. Evaluate urine osmolality, creatinine clearance, and thyroid function periodically during lithium treatment.

Other tests that may be indicated or helpful include the following:

Electroencephalography - For patients with a history or presentation that is suggestive of seizure disorder
Electrocardiography - For patients who will be treated with a TCA
Liver function tests and thyroid function tests (triiodothyronine [T3], thyroxine [T4], and thyroid-stimulating hormone [TSH]) to rule out thyroid disease
Children’s Depression Inventory or Patient Health Questionnaire 9 for Adolescents - Simple self-report surveys that may assist in determining the severity of childhood depression

Treatment & Management

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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.

Pediatric Depression Workup

Approach Considerations

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