Treating Childhood and Adolescent Depression

Treating Childhood and Adolescent Depression

ASSESMENT
The single most useful tool in the diagnosis of depressive disorders in children and adolescents is the comprehensive psychiatric diagnostic evaluation, including interviews with the child, parents, and collateral informants, such as teachers and social services personnel. The psychiatric assessment of depressed children and adolescents can be difficult and must be performed by a clinician trained to consider how developmental and cultural factors impact the patient's clinical presentation. Patients may have difficulty expressing feelings, or be irritable and uncooperative. However, when appropriately assessed, depressed youth report the common symptoms of major depressive disorder (MDD) or dysthymic disorder (DD).

The longitudinal course of the illness can be documented with a mood lifetime chart and a mood diary. Standardized interviews developed for research settings are too long for use in clinical settings, require special training, and are not suitable for young children. Psychiatric symptom checklists derived from these standardized interviews and DSM-IV symptom categories have been developed and may be useful in clinical settings. Popular self-administered and clinician-administered rating scales are not recommended for diagnosing clinical depression, but can be used to screen for symptoms, assess the severity of depressive symptoms, and monitor clinical improvement. It is important for the clinician to assess the patient's global functioning as well as clinical symptoms both initially and on an ongoing basis to monitor response to treatment.

TREATMENT
The treatment of depressive youth should be provided in the least restrictive treatment setting that is safe and effective for a given patient. Selection of treatment setting in the continuum of care (e.g. outpatient, partial hospitalization or day treatment, inpatient, and residential) depends on the availability of a safe environment, the severity of the illness, the motivation of the patient and/or his family toward treatment, and the severity of additional psychiatric (e.g. substance abuse) or medical conditions. click here to read the whole article

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