Depression in Children and Adolescents: Remember the comorbidities

by Prof. Dr. med. Claudia Mehler-Wex, Dr. med. Michael Kölch in volume 9/2008

The diagnosis of depressive disorders in children and adolescents requires good and profound exploration and expertise. I have seen patients referred with the diagnosis of attention deficit-hyperactivity disorder (ADHD), who have turned out to be suffering from depression. In addition, the symptoms of aggression and agitation in adolescents may serve to mask the manic or hypo-manic phase of bipolar disorder (1, 2). Addictive and affective disorders are not rare. Intake of ad-dictive drugs can be a form of self-medication. Depressive symptoms in adolescents may also indicate psychotic development, which may start with purely negative symptoms.

The discussion on the increased risk of suicide during antidepressive treatment has often been biased. There is in fact growing evidence of increases in adolescent suicide because of restraints in prescription. My personal experience concerning the prescription of antidepressives to adolescents with depressive disorders has been positive. In any case, the issue of suicidal tendencies should always be addressed openly and be observed. It must be distinguished from impulses to self-injury or self-injuring behavior, for example, in post-traumatic stress disorder (reduction in stress).

Additional administration of an (atypical) neuroleptic has had favorable results in depressive disor-ders with mood fluctuations, tendency to ruminate and sleep disorders, as well as for suicidal thoughts. We are aware that treatment of depression is unpromising with drugs alone. A current study from the USA (3) demonstrates the superiority of a combination of behavioral therapy and antidepressives. In my experience, the combination of various psychotherapeutic procedures and involvement of the family system can be expedient.
DOI: 10.3238/arztebl.2008.0363a


Giulio Calia
LWL-Klinik Hamm, Kinder- und Jugendpsychiatrie,
Psychotherapie, Psychosomatik
Heithofer Allee 64
59071 Hamm
Germany
[e-mail]

Conflict of interest statement
The author has received postgraduate training on schizophrenia from
the company Janssen-Cilag GmbH, who paid his travel costs.

References

1. Lewinsohn P, Klein D, Seeley J: Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, co-morbidity, and course. J Am Acad Child Adolesc Psychiatry 1995; 34: 454–63.

2. Carlson GA: Annotation: Child and adolescent mania-diagnostic considerations. J Child Psychology and Psychiatry 1990; 3: 331–41.

3. Brent D, MD, Emsile G, MD, Clarke G, PhD et al.: Switching to another SSRI or to Venflaxine with or without behavioral therapie for adolescents with SSRI-restistant depression – The TORDIA randomized controlled trial. JAMA. 2008; 229: 901–13.