Description

• Major depressive disorder (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.
• 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

• 6–12% of adolescents; it is twice as common in females as males (1).
• During adolescence, the cumulative probability of depression ranges from 5% to 20%.

Etiology and Pathophysiology

• Neurobiologic changes can contribute (HPA axis overactivity, serotonergic modulation of emotional processing pathways, decreased dopaminergic reward processing).
• External factors may contribute such as substance use, adverse childhood events, or inadequate social network.

Genetics

• Offspring of parents with depression have 3 to 4 times increased rates of depression.
• Family studies indicate that anxiety in childhood tends to precede adolescent depression.

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 (2)
• 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

• Child and adolescent mental health may be improved by successfully treating maternal depression.
• The United States Preventive Services Task Force (USPSTF) recommends the screening of adolescents (12 to 18 years of age) for MDD with systems in place to ensure accurate diagnosis, appropriate treatment, and follow-up. Current evidence is insufficient to assess benefits and harms for screening children aged ≤11 years.

Commonly Associated Conditions

Generalized anxiety disorder, behavioral disorders, substance abuse, and eating disorders