Depression in children and adolescents is underdiagnosed and undertreated. In children and adolescents, depression has a great impact on personal growth and development, school performance, and family and interpersonal relationships.
Depressive disorders in adolescence are associated with serious behavioral disorders (drug use, sexual promiscuity, criminal behaviors and aggressiveness), so that, in addition to their own personal cost, they can carry a serious social cost.
Major depression is one of the main risk factors for suicide in adolescents, therefore we must always ask the patient and their relatives about suicidal ideation or death wishes. There is evidence of the continuity of depressive disorder in adulthood, which implies high rates of psychiatric consultations and hospitalizations, work problems and relationship problems in the future.
Depressive disorders affect people of any age, economic status and cultural level and involve a great cost for the individual, the family, the health system and the community in general. Although there are numerous studies on the prevalence, diagnosis and treatment of depression in adulthood, there are few studies carried out among the child and adolescent population. Their results are also variable, due to the diagnostic difficulty at this age, the diagnostic criteria used, or the interview techniques used. Given the peculiarities of depression in childhood and adolescence, it is important to have professionals in primary care and in child and adolescent mental health who have training and experience in managing the disorder at these ages, as well as having the necessary resources for its diagnosis and treatment.
According to the data provided by the National Health Survey (2006) , the prevalence of major depressive disorder (MDD) is estimated at 1.8% in 9-year-old children, 2.3% in 13 and 14-year-old adolescents, and 3.4% in 18-year-olds. Before puberty, the prevalence of depression does not differ according to sex. Among adolescents, however, the prevalence is higher for the female sex, with a ratio of 2:1. Depressive disorders among adolescents often have a chronic, ups and downs, and there is a 2- to 4-fold higher risk of persistence of the disease into adulthood.
Although the data is yet to be confirmed, it is believed that with each generation the risk of presenting a depressive disorder at an increasingly young age increases (genetic anticipation).
The symptoms are marked by the age of the child and can be grouped according to their evolutionary development6. In early childhood, irritability is the hallmark of depression. Among adolescents, the cardinal symptoms are apathy (loss of interest) and anhedonia (inability to experience pleasure).
Table 1 summarizes the main accompanying clinical symptoms in childhood and adolescent depression according to age.
The diagnosis of depressive disorder is clinical and is made through a detailed history of the child and parents and a mental status examination. The information provided by the school environment can also be very useful.
In the clinical interview you should:
Assess the current depressive episode (symptoms, impact on global functioning, possible etiological factors). It is essential to ask the child and the parents about ideas of death or suicide.
Knowing possible previous episodes of the patient and family psychiatric history.
In addition, a complete physical and general analytical examination is necessary. Biological and complementary tests will be requested if they are considered indicated for the differential diagnosis of other
Between 40% and 90% of depressed adolescents have a comorbid disorder and at least 20–50% have 2 or more. Most of them start before the first depressive episode, except for drug abuse and panic disorder, which usually begin in the late teens. The most frequent are conduct and anxiety disorders.