Is depression a disorder exclusive to adults?
Throughout history and until relatively recently, depressive disorder in childhood was considered non-existent.
Currently, the same diagnostic criteria are considered for adults as for children, but with some nuances since the symptoms in childhood and adolescence are different from those that occur in adulthood.
Globally, it is estimated that 2% of the child population may be affected by depression , and that it affects both sexes equally, although some studies suggest a predominance in males. Later, in adolescence, the prevalence increases to 4%, and the frequency among women becomes comparable to that of adulthood.
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Depression can present very variable symptoms and causes some authors to speak of "masked depression" or to take it into account along with certain accompanying manifestations or disorders (anxiety disorder, somatization or pain in the youngest or behavioral disorder with or without consumption of toxins in the oldest).
The fact that it presents itself "masked" or accompanying other disorders makes it difficult to diagnose depressive disorder in the pediatric population.
While in the adult population the most common symptoms of depression are:
- Persistent sadness
- Inability to experience pleasure from habitual activities
- Feeling of guilt.
- Fatigue.
- Loss of interest and initiative.
- Difficulty concentrating.
- Agitation or slowness of movement.
- Sleep or appetite disorder.
- Suicidal ideation.
In children, the most frequent symptoms of depression are:
- Irritability
- To express unpleasant, uncomfortable, or annoying emotions
- Somatic complaints (headaches, nausea, abdominal pain)
- Social isolation.
- Suicidal ideation is similar in children and adolescents, although attempts are more frequent in the latter.
How is depression diagnosed in childhood?
A diagnosis of a depressive episode requires a minimum duration of symptoms of two weeks and a change in usual functioning. There are some signs to watch for, such as changes in school performance, relationships with other children, or within the family.
Depressive disorder in children usually begins slowly and progressively, with the expression of symptoms being more behavioral (behavioral problems at home and/or school) and somatic (nonspecific pains) than emotional ones.
This explains the difficulty in diagnosis and why it is sometimes called masked depression . The opposite is true in the adult population, where it usually has an acute onset and symptom-free periods (episodic course).
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For diagnosis, a clinical interview by a clinical specialist expert in child and adolescent psychopathology is necessary, who must take into account the different manifestations, as well as the circumstances of the environment in order to design the intervention plan.
The treatment of depressive disorder in childhood should be comprehensive, taking into account psychotherapeutic and psychosocial aspects, and the indication of psychopharmacological treatment according to the case.
The high placebo response shown by children makes it difficult to obtain results that prove the effectiveness of psychotropic drugs and antidepressants in particular.
Psychotherapy is the first-line treatment. No specific orientation or psychotherapy has been shown to be more effective than another.
The psychiatrist may consider combining psychopharmacological treatment with an antidepressant when psychotherapy is ineffective, that is, when no improvement is seen after 4 or 6 sessions, and the treatment should be maintained for at least 6 months after the remission of symptoms.
Hospital admission should be considered in cases of complex psychopathology, that is, if the patient presents with psychotic symptoms (altered perceptions, including hallucinations, delusional thinking, and loss of touch with reality), or if the psychiatrist observes a significant risk of suicide. In this regard, the ability of those around the patient to manage the situation and the severity of the symptoms are crucial.
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