General Description
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision. Washington, DC.
Depression is broken down into 3 depressive disorders. Major Depression Disorder (296.xx), Dysthymic Disorder (300.4), and Depressive Disorder Not Otherwise Specified (311) . The way a Major Depression Disorder is categorized is by whether it is a single episode (296.2x) or recurrent (296.3x ) this depends on the how many Major Depressive Episodes occur.
Major Depressive Disorder (296.xx)
The main feature of this disorder is a clinical course that is characterized by one or more Major Depressive Episodes and there is no history of Manic, Mixed, or Hypomanic episodes. This disorder has two subtypes Major Depressive Disorder, Single Episode (296.2x) and Major Depressive Disorder, Recurrent (296.3x)
Dysthymic Disorder (300.4)
The major feature of Dysthymic Disorder is a depressed mood that occurs almost everyday for most of the day for at least one year for children and adolescents. One sign of this disorder is children and adolescents may seem to have an irritable mood. There are 3 subtypes of this disorder, Early onset , which occurs before the age of 21 years old and individuals are more likely to have major depressive episodes; Late onset , which occurs after 21 years old; and With Atypical Features, if the individual has mood reactivity, and (at least two of the following) increased appetite or weight gain, sleeps more than normal, leaden paralysis, or a extreme sensitivity to interpersonal rejection.
Depressive Disorder Not Otherwise Specified (311)
Any depressive disorder that does not meet the criteria for a specific disorder can fall under Depressive Disorder Not Otherwise Specified. Some examples include Minor Depressive Disorder, Recurrent Brief Depressive Disorder, etc.
Diagnostic Criteria
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision. Washington , DC.
An individual could be diagnosed with Major Depressive Disorder, Single Episode (296.2x) if they have the following symptoms.
- The individual had one Major Depressive Episode.
- The Major Depressive Episode is not justified by Schizoaffective Disorder, is not superimposed Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
- There has never been a Manic, Mixed, or Hypomanic Episode. Except if the individual had these episodes due to a substance, medical condition, or due to a treatment.
An individual could be diagnosed with Major Depressive Disorder, Recurrent (296.3x) if they have the following symptoms.
- The individual had two or more Major Depressive Episodes. In order for episodes to be consider separate they must at least 2 consecutive months apart.
- The Major Depressive Episode is not justified by Schizoaffective Disorder, is not superimposed Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
- There has never been a Manic, Mixed, or Hypomanic Episode. Except if the individual had these episodes due to a substance, medical condition, or due to a treatment.
An individual could be diagnosed with Dysthymic Disorder (300.4) if the follow symptoms are seen.
- Depressed or irritable mood in children almost every day for most of the day for at least 1 year. (two years in adults)
- While depressed at least two of the following are seen:
- Lack of appetite or overeating
- Inability to sleep or too much sleeping
- Lack of energy or always feeling tired
- Lack of self-esteem
- Lack of concentration or inability to make decisions
- Feeling of loss of hope
- For the 1 year (2 years for adults) the child has always had they symptoms in 1 and 2.
- The child has not had a Major Depressive Episode for the full year and the symptoms can not be justified by chronic Major Depressive Disorder, or Major Depressive Disorder, in Partial Remission.
- There has never been a Manic, Mixed, or Hypomanic Episode and never the symptoms met for Cyclothymic Disorder.
- The symptoms can not be justified by chronic a Psychotic Disorder, such as Schizophrenia.
- They symptoms are not due to a substance, or medical condition.
- The symptoms cause obvious stress on the individual's ability to function in social and other important setting of life.
Etiology
National Institute of Mental Health, 2004) American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision. Washington , DC.
Most research is uncertain of the cause of depression but researchers determine that both biological and environmental factors can contribute to the onset of depression in children. (Sokolova, 2003)
Factors that have been linked with depression are stress, cigarette smoking, a loss of a parent or loved one, break-up of a romantic relationship, conduct or learning disorders, chronic illnesses (such as diabetes), abuse or neglect, and other trauma including natural disasters.
Dysthymic Disorder is more common in individuals with first-degree biological relatives with Major Depressive Disorders or Dysthymic Disorder.
Comorbidity
Individuals with Depression are also more likely to develop Psychiatric Disorders (40 to 70%), Anxiety Disorder (30 to 80%), ADHD or Oppositional Defiant Disorder (10 to 80%), and be involved in Substance Abuse (20 to 40%).
Prevalence
(National Institute of Mental Health, 2004) American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision. Washington , DC.
Up to 2.5% of children and up to 8.3 % of adolescents in the U.S. suffer from depression. It is estimated that in 9 to 17-year-olds depression is more than 6 percent in a 6-month period, with 4.9 percent having major depression. Depression onset is occurring earlier in life today than in past decades. Early-onset depression is most likely to continue, and follow a child into adulthood. Depression in youth may also predict more severe illness in adult life. Depression often occurs with other mental disorders, most commonly anxiety, disruptive behavior, or substance abuse disorders in children and adolescent.
As children both males and females have an equal chance of developing depression. During adolescence females are twice as likely to develop depression then adolescence males. Also, a child with a family history of depression is more likely to develop depression.
The lifetime prevalence of Dysthymic Disorder is about 6%, with a point prevalence of about 3%. As adults females are 2 to 3 times more like to develop Dysthymic disorder then men.
EBP Treatment Approaches
Listed below are either evidence-based practices or promising practices
that have been successful at treating Depressive Disorders.
Psychosocial Treatments
- Cognitive Behavioral Therapy
- Family Systemic Therapy
- Interpersonal Therapy
- Combined Treatments
- Group Therapy
Pharmacological Treatments
(Click on Medications)
References
Jureidini, J.N.; Doecke C. J.; Mansfield, P. R.; Haby, M. M., Menkes, D. B.; Tonkin, A. L. (2004, Apr.). Efficacy and safety of antidepressants for children and adolescents. BMJ (328), 879-883.
Moore, M. and Carr, A. (2001). What works with children and adolescents: a critical review of psychological interventions with children, adolescents, and their families. Depression. pp.203 - 232.
Links
British Medical Journal
APA Practice Guideline
Practice Guideline Clearing House
Diagnosis, Treatment, Research Gateway
National Alliance of Research on Schizophrenia and Depression
Seasonal Affective Disorder Gateway
Postpartum Depression Gateway
National Alliance for the Mentally Ill
Dual Diagnosis Advocacy Group
Workbook Publishing
The American Academy of Child and Adolescent Psychiatry
Fact Sheets
Fact Sheets from the American Academy of Child and Adolescent Psychiatry
Note - Click on topic. (Please note disclaimer).
The AACAP developed Facts for Families to provide concise and up-to-date information on issues that affect children, teenagers, and their families.
The AACAP website includes facts, statistics, and overviews of different problems children and adolescents face and different mental health disorders that affect children and adolescents.
Fact Sheets from the National Institute of Mental Health
Note - Click on "select a topic".
NIMH offers a variety of publications and other educational resources to help people with mental health disorders, the general public, mental health and health care practitioners, and researchers gain a better understanding of mental illnesses and the research programs of the NIMH.
This website includes facts, statistics, pamphlets, checklists, and overviews of mental health disorders.
Fact Sheets from the National Mental Health Association
Note - Click on topic.
The NMHA offers answers to frequently asked questions, facts, statistics and overviews about different mental health disorders, as well as information about treatments and other problems that affect children and adolescents.
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