Major depression in childhood and adolescence

Major depression in children and adolescents is diagnosed by the same criteria used in the adult disorder. There is a depth of knowledge regarding the childhood disorder in the areas of natural history, comorbidity, prognosis, epidemiology, and treatment. There are no controlled studies on the efficacy of psychotherapy for the treatment of childhood depression and only a few controlled studies on the efficacy of pharmacologic therapy. Current clinical practice combines individual psychotherapy, family intervention and education, and tricyclic antidepressant therapy in doses of 2 to 5 mg/kg to yield serum levels greater than 200 ng/ml for the treatment of major depression in children. Electrocardiograms should be performed prior to each increase in dose. Mood and cognitive functioning rapidly return to baseline levels following appropriate treatment but interpersonal difficulties tend to remain after resolution of the depression.