Unipolar depression in childhood is relatively common and characterized by core symptoms of low mood, anhedonia, and fatigue that persist for at least two weeks and negatively impact functioning. Sleep is often disturbed and children may fail to gain weight rather than lose it. Risk factors include abuse, family discord, losses or bereavements, bullying, low socioeconomic status, neglect, substance abuse in the family, and traumatic life events. Treatment involves psychoeducation, supportive care, cognitive behavioral therapy, interpersonal therapy, or brief family therapy. For moderate to severe cases, fluoxetine may be used for children 12-18 years old.

1. Unipolar depression
in childhood
K. Kavindya M. Fernando
JMJ 1

2. Unipolar Depression
• Relatively common
• Core symptoms remain
• Low mood, anhedonia and fatigue
• Mood may also irritable
• Symptoms must be present for at least 2
weeks
• And have a negative effect upon functioning
JMJ 2

3. Unipolar Depression
• Sleep often disturbed
• But may not have classical pattern of early
morning wakening
• Rather than weight loss, children may fail to
gain weight
• Occasionally have physical symptoms
• Abdominal pain, headaches & fatigue
JMJ 3

4. Prevalence
• Prepubertal child – 1-2%
• Adolescents – 3-8%
• In a younger child male : female = equal
• In adolescent 1:3
JMJ 4

5. Environmental and social
etiological factors
• Abuse at an early age
• Family discord
• Criminality in the
family
• Losses or
bereavements
• Attachment
difficulties
• Bullying
• Low-income family
• Neglect
• Family substance abuse
• Traumatic life events
• Maternal-child conflict
• Good academic
achievement
• Social isolation
• Unstable or
unpredictable family
environment
JMJ 5

6. Management
• If any of the features present, child should
be referred to a psychiatrist
• Moderate, severe or psychotic depression
• Mild depression which had not responded to
interventions in primary care
• Recurrance of depression after recovery from a
moderate to severe episode
• Self-neglect
• Active suicidal ideations
JMJ 6

7. Management
• All children and their families should receive
• Psychoeducation
• Self-help materials
• Advice about diet, exercise & sleep hygiene
JMJ 7

8. Treatment of mild
depression
• Appropriate supportive treatment
• Arrange a follow-up in 2 weeks (“watchful
waiting”)
• If child not improved
• Offer guided self-help or a short course of CBT
JMJ 8

9. Treatment of moderate to
severe depression
• Individual CBT
• Interpersonal therapy
• Brief family therapy
• If there is no improvement after 12 weeks
• Consider treatment pharmacotherapy
• In children 12-18 years
• Fluoxatine 1st line medication
• Try to avoid using medication in children less
than 12 years
JMJ 9

10. Treatment of moderate to
severe depression
• Continue medication for 6 months after
symptom remission
• Then slowly tapered to avoid withdrawal
symptoms
• Children should be reviewed for at least 12
months after their recovery
JMJ 10

11. Thank You!
JMJ 11