Depression, Adolescent

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  • DSM-5 depressive disorders include disruptive mood dysregulations disorder (DMDD), major depressive disorder (MDD), persistent depressive disorder, premenstrual dysphoric disorder, substance/ medication-induced depressive disorder, and other nonspecific depression. This chapter focuses on MDD.
  • MDD is a primary mood disorder characterized by sadness and/or irritable mood with impairment of functioning; abnormal psychological development; and a loss of self-worth, energy, and interest in typically pleasurable activities.
  • DMDD is characterized by having severe, recurrent outbursts along with persistent irritability and anger.
  • Persistent depressive disorder is characterized by a depressed mood for most days lasting at least 1 year in a child/adolescent.
  • Adolescents with depression are likely to suffer broad functional impairment across social, academic, family, and occupational domains, along with a high incidence of relapse and a high risk for substance abuse and other psychiatric comorbidity.


During adolescence, the cumulative probability of depression ranges from 5% to 20% (1).

  • MDD: 6–12% of adolescents; twice as common in females
  • DMDD: 2–5%; more prominent in males (2)

Etiology and Pathophysiology

  • Unclear; low levels of neurotransmitters (serotonin, norepinephrine) may produce symptoms; decreased functioning of the dopamine system also contributes.
  • External factors may affect neurotransmitters independently.
  • Hormonal changes during puberty

  • Offspring of parents with depression have 3 to 4 times increased rates of depression compared with offspring of parents without mood disorder (1).
  • Family studies indicate that anxiety in childhood tends to precede adolescent depression (1).

Risk Factors

  • Increased 3 to 6 times if first-degree relative has a major affective disorder; 3 to 4 times in offspring of parents with depression
  • Prior depressive episodes
  • History of low self-esteem, anxiety disorders, attention deficit hyperactivity disorder (ADHD), and/or learning disabilities
  • Increased screen time (3)
  • Female gender
  • Low socioeconomic status
  • General stressors: adverse life events, difficulties with peers, loss of a loved one, academic difficulties, abuse, chronic illness, and tobacco abuse

General Prevention

Insufficient evidence for universal depression prevention programs (psychological and social)

  • Some evidence indicates that child and adolescent mental health can be improved by successfully treating maternal depression (1)[A].
  • Agency for Healthcare Research and Quality (AHRQ) recommends the screening of adolescents (12 to 18 years of age) for MDD when systems are in place to ensure accurate diagnosis, appropriate treatment, and follow-up.

Commonly Associated Conditions

  • 2/3 of adolescents with depression have at least one comorbid psychiatric disorder.
  • 20% meet the criteria for generalized anxiety disorder.
  • Also associated with behavioral disorders, substance abuse, eating disorders

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