Overview
Recurrent major depressive disorder (MDD) is a common, chronic condition that often persists into adulthood 2. It is frequently associated with comorbid psychiatric disorders, increased risk of suicide, substance abuse, and behavioral problems 2.Diagnosis
Child and adolescent depressive disorders are often chronic and familial 2.
Depressed youth frequently experience poor psychosocial, academic, and family functioning 2.Management
Both psychotherapy and pharmacotherapy are beneficial for the acute treatment of depressive disorders in youth 2.
The choice of initial therapy depends on clinical and psychosocial factors and therapist expertise 2.
Psychotherapy may be the first treatment for most depressed youth 2.
Antidepressants should be considered for patients with psychosis, bipolar depression, severe depressions, or those who do not respond to psychotherapy 2.
All patients require continuation therapy, and some may need maintenance treatment 2.
Electroconvulsive therapy (ECT) is endorsed as a principal treatment approach for MDD 1. Long-term cognitive impairment from ECT may be influenced by assessment tool sensitivity and specificity 1.Special Populations
Child and adolescent depressive disorders are common, chronic, familial, and recurrent, often persisting into adulthood 2.
These disorders appear to be manifesting at an earlier age in successive cohorts 2.Key Recommendations
Both psychotherapy and pharmacotherapy are beneficial for the acute treatment of youth with depressive disorders 2. (Evidence: Moderate)
Antidepressants must be considered for patients with psychosis, bipolar depression, severe depressions, and those who do not respond to an adequate trial of psychotherapy 2. (Evidence: Expert opinion)
Electroconvulsive therapy (ECT) is a principal treatment approach for major depressive disorder 1. (Evidence: Moderate)References
1 Guo Q, Wang Y, Guo L, Li X, Ma X, He X et al.. Long-term cognitive effects of electroconvulsive therapy in major depressive disorder: A systematic review and meta-analysis. Psychiatry research 2024. link
2 . Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. AACAP. Journal of the American Academy of Child and Adolescent Psychiatry 1998. link