Chronic Depressive Disorders in Children

Chronic Depressive Disorders

• Persistent Depressive Disorder (P-DD) is more chronic than Major Depressive Disorder (MDD).
• Symptoms include poor emotion regulation, persistent sadness, self-deprecation, low self-esteem, anxiety, irritability, anger, and temper tantrums.
• Children with both MDD and P-DD experience greater impairment than those with only one disorder.

Prevalence

• P-DD prevalence: about 1% in children and 5% in adolescents.
• MDD is the most common comorbid disorder with P-DD, affecting 70% of children diagnosed with Depression.
• 50% of children with P-DD have additional nonaffective disorders before dysthymia.

Onset, Course, and Outcome

• Typical onset for P-DD occurs around ages 11-12, with a long duration ranging from 2 to 5 years.
• Those with P-DD are at increased risk for developing MDD, anxiety disorders, and conduct disorders.

Associated Characteristics

• Intellectual and academic functioning may suffer due to difficulty concentrating, loss of interest, and decreased thought and movement speed.
• Cognitive biases include negative thinking, hopelessness, suicidal ideation, and pessimistic outlook on life.
• Social struggles include few close friendships, social withdrawal, and dysfunctional family relationships.

Depression and Suicide

• A significant number of youth with depression contemplate suicide, with females at considerable risk.
• Peak ages for first suicide attempt linked to depression are 13 and 14.

Theories of Depression

• Psychodynamic Theories: Focus on conversion of aggressive instincts into depressive affects due to loss of a love object.
• Behavioral Theories: Stress the role of environmental consequences and lack of positive reinforcement in depression onset.

Cognitive Theories

• Center on the link between negative thinking and mood; highlight "depressogenic" cognitions that contribute to depressive symptoms.
• The Hopelessness theory posits that individuals prone to depression engage in negative attributional styles.

Other Theories

• Explore concepts such as self-control, interpersonal influence, socioenvironmental factors, and neurobiological aspects.

Causes of Depression

• Multiple pathways to depression arise from genetic predispositions and environmental stressors.
• Familial behaviors, stressful life events, and prolonged emotional distress during childhood significantly contribute to its development.

Influences on Childhood Depression

• Risk of developing depression increases by 30-45% if a parent has depression.
• Neurobiological factors include abnormalities in brain regions governing emotional regulation and hormone dysregulation (HPA axis).
• Effective treatments include Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy for Adolescents (IPT-A); SSRIs are less effective than these therapeutic interventions.

Major Depressive Disorder (MDD)

• MDD prevalence in children aged 4-18 ranges from 2% to 8%, increasing two- to threefold during adolescence.
• High comorbidity rates with disorders like anxiety, ADHD, and conduct disorders are observed.
• Females are at greater risk post-puberty, and symptoms may appear gradually or suddenly, with average episodes lasting around eight months.

Bipolar Disorder in Children and Adolescents

• Symptoms may include mood volatility, psychomotor agitation, and classic mania signs such as racing thoughts.
• MDD can coexist with bipolar disorder; prevalence in youths aged 7-21 is between 0.5 to 2.5%.
• Treatment often involves monitoring, education, medication (like lithium), and psychotherapeutic interventions.

Overview of Mood Disorders

• Mood disorders encompass a spectrum from severe depression to extreme mania and are divided into depressive and bipolar disorders.
• Children’s depression can impair daily routines, social relationships, and academic performance, often accompanying anxiety or conduct disorders.
• The expression of depression evolves with age, becoming more identifiable in preteens through symptoms of low self-esteem and self-blame.