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Clinical Presentation and Course of Depression in Youth: Does Onset in Childhood Differ From Onset in Adolescence?

NCJ Number
Journal of the American Academy of Child & Adolescent Psychiatry Volume: 43 Issue: 1 Dated: January 2004 Pages: 63-70
Boris Birmaher M.D.; Douglas E. Williamson Ph.D.; Ronald E. Dahl M.D.; David A. Axelson M.D.; Joan Kaufman Ph.D.; Lorah D. Dorn Ph.D.; Neal D. Ryan M.D.
Date Published
January 2004
8 pages
This article compares the clinical presentation, course, and parental psychiatric history between children and adolescents with major depressive disorder.
There is controversy regarding whether childhood-onset major depressive disorder (MDD) is associated with a greater hazard of recurrence. Some studies have suggested that adolescent MDD is more likely to continue into adulthood than childhood MDD, indicating that the appearance of MDD during adolescence conveys a worse prognosis compared to childhood-onset MDD. A limitation of the existing studies comparing the courses of child-onset and adolescent-onset MDD is that the two have not been examined within the same study. This study simultaneously and prospectively examined the results of other studies that have examined the clinical picture, course, and parental history for mood disorders in a sample of children and adolescents with MDD. A group of prepubertal children and postpubertal adolescents were assessed with structured interviews for psychopathology and parental psychiatric history and followed once every 2 years for approximately 5 years. In general, the results found that with the exception of more melancholic symptoms in the depressed adolescents, children and adolescents have similar depressive symptomatology, duration, and severity of the index depressive episode, rates of recovery and recurrence, comorbid disorders, and parental history of psychiatric disorders. During the follow-up period, approximately 85 percent of the depressed children and adolescents recovered. About 40 percent of the subjects had at least one recurrence after they recovered. Increased guilt and female sex predicted longer episodes. Child’s prior history of MDD and father’s MDD were associated with a lower rate of recovery. Mother’s behavioral disorder was associated with an increased rate of recovery. Father’s MDD and female sex predicted an increased risk for recurrence. 2 figures, 2 tables, 54 references