"Parents and children should work with their health care provider to determine the best and most appropriate treatment."

"Although changing from one SSRI to another has generally not been shown to be beneficial, one study showed that citalopram (Celexa) did not seem to cause sexual impairment in patients who had experienced such events with another SSRI."

Depression in Boys and Adolescent Males


Only in the past two decades has depression in children been taken very seriously. Research has revealed that depression is occurring earlier in life today than in past decades. In addition, research has shown that early onset depression often persists, recurs, and continues into adulthood, and that depression in youth may also predict more severe illness in adult life. An NIMH sponsored study of 9 to 17 year olds estimates that the prevalence of any depressive disorder is more than 6 percent in a six month period, with 4.9 percent having major depression. Before puberty, boys and girls are equally likely to develop depressive disorders. After age 14, however, females are twice as likely as males to have major depression or dysthymia. The risk of developing bipolar disorder remains approximately equal for males and females throughout adolescence and adulthood.

The depressed younger child may say he is sick, refuse to go to school, cling to a parent, or worry that the parent may die. The depressed older child may sulk, get into trouble at school, be negative and grouchy, and feel misunderstood. Signs of depressive disorders in young people are often viewed as normal mood swings typical of a particular developmental stage. In addition, health care professionals may be reluctant to prematurely label a young person with a mental illness diagnosis. However, early diagnosis and treatment of depressive disorders are critical to healthy emotional, social, and behavioral development. Depression in young people frequently co occurs with other mental disorders, most commonly anxiety, disruptive behavior, or substance abuse disorders, as well as with other serious illnesses such as diabetes.

Among both children and adolescents, depressive disorders confer an increased risk for illness and interpersonal and psychosocial difficulties that persist long after the depressive episode is resolved; in adolescents, there is also an increased risk for substance abuse and suicidal behavior. Unfortunately, these disorders often go unrecognized by families and physicians alike.

Although the scientific literature on treatment of children and adolescents with depression is far less extensive than that for adults, a number of recent studies have confirmed the short term efficacy and safety of treatments for depression in youth. An NIMH funded clinical trial of 439 adolescents with major depression found that a combination of medication and psychotherapy is the most effective treatment. Additional research is needed on how best to incorporate these treatments into primary care practice.

Bipolar disorder, although rare in young children, can appear in both children and adolescents. The unusual shifts in mood, energy, and functioning that are characteristic of bipolar disorder may begin with manic, depressive, or mixed manic and depressive symptoms. It is more likely to affect the children of parents who have the illness. Twenty to 40 percent of adolescents with major depression go on to reveal bipolar disorder within five years after the onset of depression.

Depression in children and adolescents is associated with an increased risk of suicidal behaviors. This risk may rise, particularly among adolescent males, if the depression is accompanied by conduct disorder and alcohol or other substance abuse. In 2002, suicide was the third leading cause of death among young males, age 15 to 24. NIMH supported researchers found that among adolescents who develop major depressive disorder, as many as 7 percent may die by suicide in the young adult years. Therefore, it is important for doctors and parents to take seriously any remarks about suicide.

NIMH researchers are developing and testing various interventions to prevent suicide in children and adolescents. Early diagnosis and treatment, accurate evaluation of suicidal thinking, and limitations on young peoples access to lethal agentsincluding firearms and medicationsmay hold the greatest suicide prevention value.

"The depressed person needs diversion and company, but too many demands can increase feelings of failure."

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"Major depression (or major depressive disorder) is manifested by a combination of symptoms (see symptoms list below) that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities."

Child Psychiatry

"A typical course of ECT entails six to 12 treatments, administered at a rate of three times per week, on either an inpatient or outpatient basis."

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"The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness."

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"Depression is especially prevalent among people with PTSD, a debilitating condition that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened."

Psychiatry Board Lectures

"Medication as a first-line course of treatment should be considered for children and adolescents with severe symptoms that would prevent effective psychotherapy, those who are unable to undergo psychotherapy, those with psychosis, and those with chronic or recurrent episodes."