Volume 2 Issue 6, June, 2012
Depression in Childhood and adolescents is under diagnosed and undertreated. This is mainly because the presentations significantly differ from that of adults and complications in diagnosis due to high rates of comorbidity. Research has shown that depression is occurring earlier than in past decades in this population. The prevalence is about 2% in children and 4.8% in adolescents, with male to female ratio 1:1 in children and 1:2 in adolescents.
The unique features of depression in children and adolescents are the course persists, recurs and continues into adulthood. It predicts a more severe illness in adulthood. The comorbidity rates are as high as 40‐50% in anxiety disorder, conduct Disorder, Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder in Children, whereas Substance related and Eating disorders in Adolescents. Suicidal Ideation is common; attempts are rare; both increase with age. Younger children present with more behavioral problems such as social withdrawal, irritability, sleep deprivation, apathy, whereas adolescents present with somatic complaints, self esteem problems, rebelliousness, poor academic performance and aggressive behavior.
The risk factors for depression in young age are presence of depression in one parent, environmental stressors, stressful life events, low academic performance and perception of lack of parental support by the child. The first episode lasts for 5‐9 months. 74% recover significantly in the 1st year. The unique features are‐(a) inspite of complete recovery , some degree of psycho social damage is always present (b)Earlier the onset of pathology, greater the harm. The risk of recurrence is greater in the first few months after 1st episode(60‐75%). Factors which predict recurrence are non‐adherence, early onset, numerous episodes, severity of episode, presence of psychotic features, stressors and co‐morbidity.
Early detection and effective treatment may reduce the impact of depression on family, social functioning, academic functioning and also reduces suicidal risk. While evaluating depression in this age group, it is important to try to get information from as many sources as possible. Fluoxetine is the only drug approved by the FDA for treatment of child and adolescent depression which has to be given for a period of 6‐12 months. Cognitive Behavioral Therapy is found to be effective in altering the negative cognition, which can have a long lasting impact. Last, but not the least, it is very difficult to treat the child without the involvement of the family, where the family needs to be educated about it being an illness and not the weakness of the child ,or difficulty in coping rather than it being a manipulative behavior. Hence, there is a need to sensitize the family, teachers and fellow medical professionals to ensure early recognition and adequate treatment for this population and prevent victimization.
Kempegowda Institute of Medical Sciences, Bengaluru
