Description

• DSM-5 depressive disorders include major depressive disorder (MDD), disruptive mood dysregulation disorder (DMDD), persistent depressive disorder (PDD), premenstrual dysphoric disorder, substance/medication-induced depressive disorder, and other nonspecific depression. This chapter focuses on MDD as it relates to the adolescent patient.
• 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.
• PDD 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.

Epidemiology

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

Prevalence

• 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); decreased functioning of the dopamine system also contributes.
• External factors may affect neurotransmitters independently.
• Hormonal changes during puberty

Genetics

• 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

• Prior depressive episodes
• History of insomnia, anxiety disorders, attention deficit hyperactivity disorder (ADHD), body dysmorphic disorder, chronic childhood illness, and/or learning disabilities
• Increased screen time (3)
• Female gender
• General stressors: adverse life events, difficulties with peers, loss of a loved one, academic difficulties, abuse, chronic illness, tobacco abuse, and low socioeconomic status
• LGBTQ identified

General Prevention

• Some evidence indicates that child and adolescent mental health can be improved by successfully treating maternal depression (1)[A].
• The United States Preventive Services Task Force (USPSTF) 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

• 20% meet the criteria for generalized anxiety disorder.
• Also associated with behavioral disorders, substance abuse, eating disorders