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Feature Article

Diagnosing and treating depression in childhood and adolescence

Michael S Gordon, Bruce J Tonge

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Abstract

Identifying depression can be a difficult and daunting task for the GP, who must separate physical symptoms from psychological distress. The core features in children and adolescents are generally the same as those in adults, but may manifest with additional age-appropriate symptoms. This article discusses the diagnosis and treatment of depression in children and adolescents.

Key Points

  • Suicidal thoughts and plans are more common in adolescents than in younger children. Special care needs to be taken to enquire about these symptoms because often adolescents will not volunteer them.
  • Depressed children under 13 years of age should not be medicated as the first line of treatment. Consider referral to a child psychiatrist or child mental health service.
  • The selective serotonin reuptake inhibitors (SSRIs) are some of the most promising antidepressants for adolescent depression. Tricyclic antidepressants should be avoided in children and adolescents – they are dangerous in overdose, produce cardiotoxic metabolites in children and might cause arrhythmias.
  • Cognitive behavioural therapy, which identifies patterns of maladaptive thinking which have led to depression in a young person, can be used by GPs trained in the technique.

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