| disease | Childhood Depression |
The existence of depression in childhood has been accepted by most scholars. Compared to the manifestations in adults, severe mood disorders, including bipolar affective disorder, are relatively rare in children.
In recent years, depression in school-age and even preschool children has attracted significant attention. Some severe cases are more commonly associated with a family history of depression, suggesting a genetic component, with the incidence rate being higher in those with a family history of depression than in the general population.
bubble_chart Diagnosis
The basic manifestations of childhood depression are similar to those in adults, but are relatively more typically associated with aspects relevant to children, such as schoolwork and play. Symptoms include a sad expression, apathy and withdrawal, reduced capacity for joy, feelings of being rejected and disliked, physical discomfort (headaches, abdominal pain, insomnia), episodes of silly and rude behavior, and persistent self-reproach. Chronic depression reflects associated anorexia, weight loss, hopelessness, and suicidal ideation. Depression may be masked by excessive hyperactivity, aggression, or antisocial behavior.
Extreme irritability and aggression, rather than depressive mood itself, are quite common. When these manifestations coexist with symptoms and signs typical of adult depressive affect, a diagnosis of mood disorder is more appropriate than adjustment disorder or conduct disorder. Mood disorders can occur in children with intellectual disabilities but may be masked by physical symptoms and behavioral disturbances. A history of periodic behavioral disturbances and a family history of bipolar disorder can aid in differential diagnosis.
The treatment of
requires an assessment of the family and social environment to identify the stressors contributing to the onset of depression. While directly treating the child, appropriate measures must also be taken for the family and social environment, with the focus of treatment being on enhancing self-esteem and its lasting effects. Short-term hospitalization may be necessary during acute episodes.
For preadolescent depression, the indications and dose ranges for antidepressant medications have not been established; it is advisable to start with a conservative dose and then increase if needed. Although relevant research is still ongoing, most clinicians believe that tricyclic antidepressants (such as imipramine at 1~2.5mg/kg daily) have adjunctive therapeutic effects. Newer medications like fluoxetine and bupropion are increasingly being used, but their safety and efficacy in children have not yet been confirmed. Personalized pharmacokinetic dosing of tricyclic antidepressants, along with monitoring plasma drug concentrations, can help determine the optimal dose. A plasma concentration of 150~250ng/ml is considered an effective therapeutic range, but the upper limit for children has not been established. An electrocardiogram should be performed before initiating tricyclic antidepressant therapy. Throughout the treatment, the PR interval and QRS complex characteristics should be monitored. Clinicians must remain vigilant for the "switch phenomenon," as childhood-onset depression is often a precursor to bipolar affective disorder.
