| 1.
Differential Diagnosis
Medical disorders can be primary or
related to major depression. These include thyroid disoder, Ebstein-Barr/chronic
fatigue, asthma, diabetes, pre-menstrual dysphoric disorder, cancers,
anemia and autoimmune disorder. A substance abuse evaluation is critical:
Heavy drinking, frequent marijuana use, and other drug use can be
caused by or occur in response to depression. Information from family
members or school personnel can often help identify depression in
teenagers.
Depression can be especially difficult to diagnose
in teens. Normal adolescent behavior is often characterized by irritability
and mood swings. As many as 40-90% of children with MDD have one or
more comorbid conditions including anxiety disorders (including social
anxiety, general anxiety obsessive compulsive disorder and PTSD),
ADHD, oppositional defiant disorder, conduct disorder, eating disorders,
learning disabilities, bipolar disorder, and somatoform illnesses.
Bipolar disorder can initially present as a depressive disorder. The
symptoms of MDD can overlap with these disorders, and it may be difficult
to determine whether the MDD, the comorbid condition, or both are
responsible for the symptoms. Other conditions to consider in children
with symptoms depression include environmental factors (stressful
home or school environment), and various medical conditions such as
hearing or visual impairment, diabetes mellitus, asthma treatments,
fetal alcohol syndrome, thyroid abnormalities, sleep disorder, and
seizure disorder. These medical conditions usually can be differentiated
from ADHD because the symptoms fluctuate with the course of disease.
In contrast, the symptoms in ADHD are persistent and pervasive.
2. DSM IV Criteria for Major
Depressive Disorder
DSM IV Criteria for Major Depressive Disorder
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A. Five or more of the following
symptoms present during the same 2-week period. At least one
of the symptoms must be either (1) depressed mood or (2) loss
of interest or pleasure:
- Depressed mood most of the day, nearly
every day, as indicated by either subjective report (e.g.
feels sad or empty) or observation made by others (e.g.
appears tearful). Note: In children and adolescents, can
be irritable mood.
- Markedly diminished interest or pleasure
in all, or almost all, activities most of the day, nearly
every day (as indicated by either subjective account or
observation made by others).
- Significant weight loss when not dieting
or weight gain (e.g. a change of more than five percent
of body weight in a month), or a decrease or increase in
appetite nearly every day. Note: In children, consider failure
to make expected weight gain.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly
every day (observable by others, not merely subjective feelings
of restlessness or being slowed down).
- Fatigue or loss of energy nearly every
day.
- Feelings of worthlessness or excessive
or inappropriate guilt (which may be delusional) nearly
every day (not merely self-reproach or guilt about being
sick).
- Diminished ability to think or concentrate,
or indecisiveness, nearly every day (either by subjective
account or as observed by others).
- Recurrent thoughts of death (not just fear
of dying), recurrent suicdial ideation without a specific
plan, or a suicide attempt or a specific plan for committing
suicide.
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B. The symptoms
do not meet criteria for a Mixed Episode |
C. The symptoms cause clinically
significant distress or impairment in social, occupational,
or other important areas of functioning. |
D. The symptoms are not due
to the direct physiological effects of a substance (e.g. a
drug of abuse, a medication) or a general medical condition
(e.g. hypothyroidism). |
E. The symptoms are not bettter
accounted for by Bereavement, i.e. after the loss of a loved
one. |
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*Source: American Psychiatric
Association: Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition, Text Revision. Washington, DC, American Psychiatric
Association, 2000. |
3. Diagnostic Tools:
The diagnosis of Depression requires that a child meet
DSM-IV criteria for more than 2 weeks and have functional impairment.
High scores on the following screening tools are therefore not diagnostic,
but can be useful to establish risk for Depression, as well as to
follow Depressive symptoms.
Columbia Depression Screen, TEEN - English
Columbia Depression Screen, TEEN - Spanish
Columbia Depression Screen, Parent - English
Columbia Depression Screen, Parent - Spanish
4. Reference:
1. Doyle
AE, et al. Diagnostic efficiency of neuropsychological test scores
for discriminating boys with and without attention deficit-hyperactivity
disorder. J Consult Clin Psychol, 2000 Jun:68(3):477-88
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