Depression in adolescence

Abstract

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with substantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress. Inherited risks, developmental factors, sex hormones, and psychosocial adversity interact to increase risk through hormonal factors and associated perturbed neural pathways. Although many similarities between depression in adolescence and depression in adulthood exist, in adolescents the use of antidepressants is of concern and opinions about clinical management are divided. Effective treatments are available, but choices are dependent on depression severity and available resources. Prevention strategies targeted at high-risk groups are promising.

Figure 1. Detection of depression in adolescents in non-specialist settings

*If patient scores <2, generally no further action is needed.

Figure 2. Treatment strategies for adolescents with depression*

CBT=cognitive behavioural therapy; IPT=interpersonal therapy. *Adapted guidance.^, Guidelines in different countries vary. ^†If no specialist services, treat mild depression with psychosocial strategies and moderate to severe depression with psychosocial strategies, medication, and careful monitoring. ^§Complications include comorbidities other than anxiety disorders (eg, eating disorders, substance misuse), suicide risk, and other medical and psychosocial factors that could make treatment with non-specialist psychosocial interventions difficult.