Depression in children and adolescents

Disease Description (Causes and Symptoms)

• Definition summary: Depression in childhood and adolescence is major depressive disorder occurring in children and adolescents. Unlike in adults, depressed mood is often not expressed outwardly and may instead appear as irritability, behavioral problems, or physical symptoms.
• Causes and pathophysiology
  • Interaction of genetic predisposition, dysfunction of neurotransmitters (such as serotonin and norepinephrine), and stress-related neurobiological responses
  • Family environment (academic stress, peer relationship problems, parental psychiatric history and parenting stress) and social factors are important
  • Developmental characteristics (immaturity in cognitive and emotional regulation) affect how symptoms are expressed
• Main symptoms
  • Persistent sadness or depressed mood, loss of interest or pleasure, fatigue, impaired concentration, and difficulty making decisions
  • Changes in sleep or appetite, guilt or feelings of worthlessness, hopelessness, and thoughts of death or suicide
  • In children and adolescents, symptoms may appear as irritability or anger, declining school performance, complaints of physical pain, social withdrawal, or behavioral problems
• Epidemiology (based on the provided data)
  • One survey (Seoul, 2005): The prevalence was 0.86% based on parent reports, but 7.37% based on self-reports by children and adolescents, indicating that parents often miss the symptoms

Treatment Methods and Precautions

• Standard treatment
  • Psychotherapy: Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) have clear supporting evidence for depression in children and adolescents (preferentially considered for mild to moderate cases).
  • Pharmacological treatment: Selective serotonin reuptake inhibitors (SSRIs) are used as first-line medications. Fluoxetine has the strongest evidence in children and adolescents (administered under evaluation and direction by a specialist). Medication selection, dosage, and monitoring are determined by a child and adolescent psychiatrist.
  • Combined treatment: For moderate to severe depression or when there is a risk of suicide, psychotherapy and medication are generally recommended together.
• Treatment duration
  • Even after symptoms improve, consider maintenance treatment for at least 6–12 months to prevent recurrence (9–12 months recommended based on the provided data).
• Acute risk management
  • Immediate evaluation, hospitalization, and a safety plan are necessary in cases of suicidal thoughts or attempts, severe functional impairment, or inability to eat or sleep.
  • When suicide-related symptoms occur, 24-hour observation and protection are necessary (immediate family intervention is recommended).
• Side effects and precautions
  • Although antidepressants such as SSRIs are effective, they may cause side effects (vomiting, diarrhea, sleep disturbances, behavioral anxiety, activation, etc.) and changes in suicidal thoughts in adolescents (monitoring is necessary during the first few weeks), so regular evaluation is required.
  • If signs of elevated mood or excessive activity (a switch to mania) appear during treatment, consult a specialist immediately.
  • Do not stop the medication on your own (gradual dose reduction is recommended).
• Lifestyle management
  • Maintain regular sleep and exercise, eat a healthy diet, regulate screen time, and establish support systems at school and home
  • When medication and psychotherapy are combined, family education and cooperation with the school can help improve treatment outcomes

Checklist Before an Outpatient Visit (Including Preparation Items and Example Questions)

• Preparation items (items that can help make the appointment go smoothly)
  • List of all medications and supplements currently being taken (including dosage and administration times)
  • Past medical history, psychiatric treatment and hospitalization history, and family history (depression, suicide, and mental illness)
  • Record of symptom changes: onset, frequency and intensity, and effects on daily functioning (school, sleep, and eating)
  • Whether there have been suicidal thoughts, plans, or attempts, and recent behavioral changes (items to report immediately)
  • School report cards, teachers’ observations, and materials related to peer relationships (if available)
  • Recent test results (such as blood tests and thyroid tests) or other medical records
• Key information to first report to the doctor during an outpatient visit (example questions)
  • "When did the symptoms begin? In what situations do they get worse?"
  • "Have you recently had difficulty falling asleep or a significant change in the amount you eat?"
  • "Have you ever had suicidal thoughts or engaged in self-harm? Are you having such thoughts now?"

Examples of General Questions to Ask the Doctor

• What are the expected effects and side effects of this medication (or treatment)?
• Once the medication is started, how quickly will the symptoms improve? How long is the treatment expected to last?
• How is suicide risk monitored? What should the family do in an emergency?
• What precautions should be taken in daily life (driving, exercise, and school activities) while taking the medication?
• How often and for how long should psychotherapy (e.g., CBT) be received?

Examples of Disease-Specific Questions

• How do you determine whether my child needs medication or whether psychotherapy alone is sufficient?
• What specific support should the family and school provide to improve behavioral and academic decline at school?

(Note: If serious self-harm or suicide risk is suspected, contact an emergency room or specialist immediately, and prioritize 24-hour protection.)