Depression and Dysthymia

Depression is a mental health condition that can make children and teens feel very sad for long periods. Kids and teens with depression have trouble enjoying things they used to love. They may also seem tired and easily annoyed. This condition is more common in teens than in younger kids.

Depression can have many negative effects on a person’s life, like missing school and not wanting to be around friends. It is normal for kids and teens to feel sad when bad things happen, but a child or teen with depression doesn’t feel better even if things change. Children and teens with depression might be at risk of thinking about or trying to hurt themselves.

What are the symptoms of Depression?

The biggest sign of depression is a change in mood. A depressed child or teen feels sad for no reason and may lose interest in things they normally enjoy. Specific symptoms include:

Core Symptoms

– Depressed or irritated mood most of the day nearly every day for two weeks or more

– Reduced or loss of interest or pleasure in activities most of the day nearly every day for two weeks or more

– Noticeable appetite changes, weight gain, or weight loss

– Sleep difficulties

– Fatigue or loss of energy

– Worthless feelings or excessive guilt

– Concentration difficulties

– Recurrent thoughts about death, thinking about or attempting suicide

Associated Symptoms

– Being easily annoyed

– Feeling hopeless

– Seeming lazy

– Difficulty making decisions

– Struggling in school

– Low self-esteem or saying negative things about themselves

– Having trouble talking to friends

Depression happens in what we call episodes, meaning that a child or teen who is depressed is unlikely to be depressed for their whole life, but rather for a period.

What is Dysthymia and how is it different from Depression?

When a child or teen goes through repeated depressive episodes, they might have Persistent Depressive Disorder or Dysthymia. Dysthymia is similar to Depression, but there are some important differences. For Dysthymia to be diagnosed, a child’s or teen’s symptoms must be present for most of the day, more often than not, for at least one year, and they must not be without symptoms for more than two months at a time. When depressed, at least two of the following symptoms must be present:

– Overeating or poor appetite

– Hypersomnia or insomnia

– Fatigue or lack of energy

– Poor self-esteem

– Poor concentration or decision making

– Feelings of hopelessness

How are Depression and Dysthymia diagnosed?

A child-adolescent psychiatrist will diagnose a child or teen with Depression or Dysthymia after checking if their mood change and/or other symptoms meet the diagnostic criteria; their symptoms have lasted at least two weeks, or one year in the case of Dysthymia; and their symptoms cause significant problems in everyday life (e.g., social, school, etc.).

The child-adolescent psychiatrist may interview and/or assess both the child and a caregiver to figure out the specific nature of the child’s depressed mood. Many practitioners also use behavior and emotion rating forms to help with the diagnosis. The practitioner will also try to determine that the child’s or teen’s mood change or persistent depressed mood is not related to something unexpected.

Depression and Dysthymia facts

Worldwide frequency of condition:

According to recent data, depression and dysthymia are estimated to affect 8% and 4% of adolescents, respectively. Over the lifetime, these conditions are estimated to affect 2.6% to 4.1% of the global population and 1.7% of the European population. Estimates made during the COVID-19 pandemic are higher.

Impact of the condition in Brazil:

Despite limited data, the estimated prevalence of depressive disorders in Brazil is 0.1% in children (5-9 years) and 2.2% in adolescents (10-19 years), with 0.02% of dysthymia and 0.06% of major depressive disorder in children, and 0.36% and 1.86%, respectively, in adolescents.

Gender ratio:

Comparative data for depression between men and women vary widely based on severity and the wide range of co-occurring disorders. Generally, women are more likely to be diagnosed than men, at a 2:1 ratio.

Peak age of onset:

The most common age of onset for depression is estimated to be 19.5 years, while the most common age of onset for mood disorders in general, including dysthymia, is 20.5 years.

Proportion of condition that emerges before age 18:

According to recent data, 13.7% of individuals with depression will have been diagnosed by the age of 18. This is similar to mood disorders in general, including dysthymia, where 11.5% of individuals will have been diagnosed by the age of 18.

What are the associated factors for Depression and Dysthymia?

Some common factors linked with Depression and Dysthymia are:

– Genetic and familial factors: Most likely a combination of multiple genes interacting with environmental factors.

– Environmental factors: These include stressful life events (e.g., maltreatment during childhood, loss of a parent), chronic diseases, as well as social challenges (e.g., family income, educational experience, racism).

– Temperament: A tendency toward feeling anxious and concerns about being harmed.

– Other health problems: These include chronic or serious illness (e.g., diabetes, significant physical injury).

What other disorders co-occur with Depression and Dysthymia?

Even though each child and teen is different, Depression and Dysthymia might often happen with anxiety disorders (e.g., Generalized Anxiety Disorder [GAD], Separation Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, etc.), substance-use disorders, Obsessive-Compulsive Disorder [OCD], and eating disorders.

How are Depression and Dysthymia treated?

Many young patients with mild depression get better with assessment and learning about the condition alone. For moderate-to-severe depression, the best treatment is a combination of therapy and medication. Caregivers and other family members are sometimes involved in treatment to learn about how their relationships may affect their child’s or teen’s mood, and to help them practice the skills they learn in therapy.

There are many therapies that effectively treat symptoms of Depression, but there are two with more support than others:

– Interpersonal therapy (IPT): This therapy decreases conflicts by teaching problem-solving skills and helping to change communication and relationship patterns. It involves the child or teen talking with a therapist about relationships with friends and family. They learn how these relationships cause good or bad feelings.

– Cognitive-behavioral therapy (CBT): This therapy teaches children and teens how their thoughts shape their feelings and behaviors. During therapy, the therapist will encourage the child or teen to return to activities they enjoyed in the past, which is called “behavioral activation.” Other CBT techniques include learning better “problem solving” and strategies that improve “emotion regulation.” Group-based CBT has been shown to be especially helpful for children and teens.

Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), alone or in combination with CBT, is the only medication with enough evidence for use to treat Depression in children and teens. Other SSRIs (e.g., sertraline, paroxetine, citalopram, escitalopram) have been studied and might be used, but have less evidence that they work. Medications can have side effects, but they are safe for children to use with proper care from their doctor. A child or teen who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

References

Clinical description, symptoms, and diagnostic information

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Child Mind Institute. (2021, September 7). Quick guide to depression. _https://childmind.org/guide/depression-in-kids-quick-guide/_

– Miller, C. (2022, December 6). What are the kinds of depression? _https://childmind.org/article/what-are-the-kinds-of-depression/_

– Steingard, R. J. (2022, October 28). What are the symptoms of Depression in teenagers? _https://childmind.org/article/what-are-the-symptoms-of-depression-in-teenagers/_

– World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. Depressive Disorders. _https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1563440232_

– World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6A70 Single Episode Depressive Disorder. _https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f57863557402/2022_

– World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6A71 Recurrent Depressive Disorder. _https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1194756772_

– World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6A72 Dysthymic Disorder. _https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f810797047_

Facts

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Global Burden of Disease Collaborative Network. (2020). Global Burden of Disease Study 2019 (GBD 2019) Results. Institute for Health Metrics and Evaluation (IHME). _https://vizhub.healthdata.org/gbd-results/_

– Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from _http://vizhub.healthdata.org/gbd-compare_. (Accessed 11/15/2022)

– Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365. _https://doi.org/10.1111/jcpp.12381_

– Sacco, R., Camilleri, N., Eberhardt, J., Umla-Runge, K., & Newbury-Birch, D. (2022). A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. European Child & Adolescent Psychiatry. _https://doi.org/10.1007/s00787-022-02131-2_

– Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. _https://doi.org/10.1037/bul0000102_

– Shorey, S., Ng, E. D., & Wong, C. H. J. (2022). Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta‐analysis. British Journal of Clinical Psychology, 61(2), 287–305. _https://doi.org/10.1111/bjc.12333_

– Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. _https://doi.org/10.1038/s41380-021-01161-7_

Associated factors

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Arango, C., Dragioti, E., Solmi, M., Cortese, S., Domschke, K., Murray, R. M., Jones, P. B., Uher, R., Carvalho, A. F., Reichenberg, A., Shin, J. I., Andreassen, O. A., Correll, C. U., & Fusar‐Poli, P. (2021). Risk and protective factors for mental disorders beyond genetics: An evidence‐based atlas. World Psychiatry, 20(3), 417–436. _https://doi.org/10.1002/wps.20894_

– Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Frontiers in Psychology, 10, 543. _https://doi.org/10.3389/fpsyg.2019.00543_

– Gardner, M. J., Thomas, H. J., & Erskine, H. E. (2019). The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis. Child Abuse & Neglect, 96, 104082. _https://doi.org/10.1016/j.chiabu.2019.104082_

– Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. _https://doi.org/10.1038/mp.2013.50_

– Kwong, A. S. F., López-López, J. A., Hammerton, G., Manley, D., Timpson, N. J., Leckie, G., & Pearson, R. M. (2019). Genetic and Environmental Risk Factors Associated With Trajectories of Depression Symptoms From Adolescence to Young Adulthood. JAMA Network Open, 2(6), e196587. _https://doi.org/10.1001/jamanetworkopen.2019.6587_

– Stirling, K., Toumbourou, J. W., & Rowland, B. (2015). Community factors influencing child and adolescent depression: A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 49(10), 869–886. _https://doi.org/10.1177/0004867415603129_

– Zajkowska, Z., Walsh, A., Zonca, V., Gullett, N., Pedersen, G. A., Kieling, C., Swartz, J. R., Karmacharya, R., Fisher, H. L., Kohrt, B. A., & Mondelli, V. (2021). A systematic review of the association between biological markers and environmental stress risk factors for adolescent depression. Journal of Psychiatric Research, 138, 163–175. _https://doi.org/10.1016/j.jpsychires.2021.04.003_

– Zheng, K., Abraham, C., Bruzzese, J.-M., & Smaldone, A. (2020). Longitudinal Relationships Between Depression and Chronic Illness in Adolescents: An Integrative Review. Journal of Pediatric Health Care, 34(4), 333–345. _https://doi.org/10.1016/j.pedhc.2020.01.008_

Co-occurring disorders

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Hambleton, A., Pepin, G., Le, A., Maloney, D., National Eating Disorder Research Consortium, Aouad, P., Barakat, S., Boakes, R., Brennan, L., Bryant, E., Byrne, S., Caldwell, B., Calvert, S., Carroll, B., Castle, D., Caterson, I., Chelius, B., Chiem, L., Clarke, S., … Maguire, S. (2022). Psychiatric and medical comorbidities of eating disorders: Findings from a rapid review of the literature. Journal of Eating Disorders, 10(1), 132. _https://doi.org/10.1186/s40337-022-00654-2_

– Hunt, G. E., Malhi, G. S., Lai, H. M. X., & Cleary, M. (2020). Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: Systematic review and meta-analysis. Journal of Affective Disorders, 266, 288–304. _https://doi.org/10.1016/j.jad.2020.01.141_

– Melton, T. H., Croarkin, P. E., Strawn, J. R., & Mcclintock, S. M. (2016). Comorbid Anxiety and Depressive Symptoms in Children and Adolescents: A Systematic Review and Analysis. Journal of Psychiatric Practice, 22(2), 84–98. _https://doi.org/10.1097/PRA.0000000000000132_

– Sharma, E., Sharma, L. P., Balachander, S., Lin, B., Manohar, H., Khanna, P., Lu, C., Garg, K., Thomas, T. L., Au, A. C. L., Selles, R. R., Højgaard, D. R. M. A., Skarphedinsson, G., & Stewart, S. E. (2021). Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Reviewand Meta-Analysis. Frontiers in Psychiatry, 12, 703701. _https://doi.org/10.3389/fpsyt.2021.703701_

– Saha, S., Lim, C. C. W., Cannon, D. L., Burton, L., Bremner, M., Cosgrove, P., Huo, Y., & McGrath, J. (2021). Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depression and Anxiety, 38(3), 286–306. _https://doi.org/10.1002/da.23113_

Interventions

– Bahji, A., Pierce, M., Wong, J., Roberge, J. N., Ortega, I., & Patten, S. (2021). Comparative efficacy and acceptability of psychotherapies for self-injury and suicidal behavior among children and adolescents: A systematic review and network meta-analysis. JAMA Network Open, 4(4), e216614. _https://doi.org/10.1001/jamanetworkopen.2021.6614_

– Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Frontiers in Psychology, 10, 543. _https://doi.org/10.3389/fpsyg.2019.00543_

– Chang, P. G. R. Y., Delgadillo, J., & Waller, G. (2021). Early response to psychological treatment for eating disorders: A systematic review and meta-analysis. Clinical Psychology Review, 86, 102032. _https://doi.org/10.1016/j.cpr.2021.102032_

– Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. H. (2016). How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry, 15(3), 245–258. _https://doi.org/10.1002/wps.20346_

– Cipriani, A., Zhou, X., Del Giovane, C., Hetrick, S. E., Qin, B., Whittington, C., Coghill, D., Zhang, Y., Hazell, P., Leucht, S., Cuijpers, P., Pu, J., Cohen, D., Ravindran, A. V., Liu, Y., Michael, K. D., Yang, L., Liu, L., & Xie, P. (2016). Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: A network meta-analysis. The Lancet, 388(10047), 881–890. _https://doi.org/10.1016/S0140-6736(16)30385-330385-3)_

– Correll, C. U., Cortese, S., Croatto, G., et al. (2021). Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: An umbrella review. World Psychiatry, 20(2), 244–275. _https://doi.org/10.1002/wps.20881_

– Viswanathan, M., Kennedy, S. M., McKeeman, J., et al. (2020). Treatment of Depression in Children and Adolescents. Agency for Healthcare Research and Quality (AHRQ). _https://doi.org/10.23970/AHRQEPCCER224_

– Zhou, X., Hetrick, S. E., Cuijpers, P., et al. (2015). Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis. World Psychiatry, 14(2), 207–222. _https://doi.org/10.1002/wps.20217_

– Zhou, X., Teng, T., Zhang, Y., et al. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: A systematic review and network meta-analysis. The Lancet Psychiatry, 7(7), 581–601. _https://doi.org/10.1016/S2215-0366(20)30137-130137-1)_