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Recognizing and treating depression in children and adolescents
1Schools of Pharmacy and Medicine, University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90089, USA. dopheide@usc.edu
Summary
Childhood depression affects 2-10% of youth and is treatable with cognitive behavioral therapy and antidepressants. Close monitoring for side effects, including suicidality, is crucial, especially with fluoxetine in adolescents.
Area of Science:
- Child and Adolescent Psychiatry
- Neurobiology
- Clinical Psychology
Background:
- Depression in youth is a significant concern, affecting 2-10% of children and adolescents.
- Diagnosis should consider depressed mood, anhedonia, somatic complaints, or behavioral changes like aggression and withdrawal.
- Risk factors include trauma, genetics, and environmental stressors.
Purpose of the Study:
- To review the clinical presentation and neurobiology of depression in youth.
- To outline appropriate treatments and strategies for improving therapeutic benefit.
- To discuss prevention of adverse outcomes, including suicide.
Main Methods:
- Literature review of clinical presentations, neurobiology, and treatment of youth depression.
- Analysis of risk factors, therapeutic interventions, and adverse effects.
- Evaluation of evidence for antidepressant efficacy and safety in different age groups.
Main Results:
- Antidepressants and cognitive behavioral therapy are effective for adolescent depression.
- Fluoxetine shows the most evidence for safety and efficacy in adolescents 12 and older.
- Limited evidence exists for antidepressants in children 11 and younger; close monitoring for suicidality is essential.
Conclusions:
- Depression in youth is common, treatable, and best managed with multimodal approaches.
- For adolescents, the benefits of antidepressants outweigh risks; multimodal treatment is recommended.
- Family and psychotherapeutic interventions are most effective for prepubertal children.