Depression is a disorder that causes persistent feelings of low mood, low energy and reduced interest. It can affect people of all ages, including children and adolescents. It is often triggered by life events, although it can happen without any apparent triggers.
Presentation
Typical symptoms of depression include:
- Low mood
- Anhedonia, a lack of pleasure in activities
- Low energy
- Anxiety and worry
- Clinginess
- Irritability
- Avoiding social situations (e.g. school)
- Hopelessness about the future
- Poor sleep, particularly early morning waking
- Poor appetite or over eating
- Poor concentration
- Physical symptoms such as abdominal pain
There are key points that need to be considered in assessing children and adolescents with depression. Particular attention needs to be given to the psychosocial contributors. It is important to ask question in private as well as taking a history with parents or others present.
- Potential triggers (e.g. loss of a family member)
- Home environment
- Family relationships
- Relationship with friends
- Sexual relationships
- School situations and pressures
- Bullying
- Drugs and alcohol
- History of self harm
- Thoughts of self harm or suicide
- Family history
- Parental depression
- Parental drug and alcohol use
- History of abuse or neglect
Management
Mild depression or low mood associated with a single negative event (e.g. loss of a family member) can be managed with watchful waiting and advice about healthy habits, such as healthy diet, exercise and avoiding alcohol and cannabis. Follow up within 2 weeks is advised.
NICE recommend referral to CAMHS for children with moderate to severe depression. CAMHS can then initiate:
- Full assessment to establish a diagnosis
- Psychological therapy as the first line treatment with cognitive behavioural therapy, non-directive supportive therapy, interpersonal therapy and family therapy
- Fluoxetine is the first line antidepressant in children, starting at 10mg and increasing to a maximum of 20mg
- Sertraline and citalopram are second line antidepressants
- When the child responds to medical treatment, it should continue 6 months after remission is achieved
- When they do not respond to medical treatment they may require intensive psychological therapy
Where there is follow up monitoring in secondary care, the mood and feelings questionnaire (MFQ) may be used to assess progress.
Admission may be required where there is high risk of self harm, suicide or self-neglect or where they may be an immediate safeguarding issue.
Last updated January 2020