Depressive disorder, which include major depressive disorder (unipolar depression), dysthymic disorder (chronic, mild depression), and bipolar disorder (manic-depressive illness), can have far reaching effects on the functioning and adjustment of people (both children and adults). 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.

The literature suggests that a combination of medication and therapy provide the best prognosis for any of the depressive disorders.

Symptoms of Major Depressive Disorder Common to Adults, Children and Adolescents:

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• Persistent sad or irritable mood

• Loss of interest in activities once enjoyed

• Significant change in appetite or body weight

• Difficulty sleeping or oversleeping

• Psychomotor agitation or retardation

• Loss of energy

• Feelings of worthlessness or inappropriate guilt

• Difficulty concentrating

• Recurrent thoughts of death or suicide

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Five or more of these symptoms must persist for two or more weeks before a diagnosis of major depression is indicated.

Signs That May Be Associated With Depression in Children and Adolescents:

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• Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomachaches or tiredness.

• Frequent absences from school or poor performance in school

• Talk of or efforts to run away from home

• Outbursts of shouting, complaining, unexplained irritability or crying.

• Being bored

• Lack of interest in playing with friends

• Among adolescents, alcohol or substance abuse

• Social isolation, poor communication

• Fear of death

• Extreme sensitivity to rejection or failure

• Increased irritability, anger or hostility

• Reckless behavior

• Difficulty with relationships

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Bipolar Disorder: Manic Symptoms-Late Adolescents/Adults

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• Severe changes in mood-either extremely irritable or overly silly and elated

• Overly-inflated self-esteem; grandiosity

• Increased energy

• Decreased need for sleep-able to go with very little or no sleep for days without tiring

• Increased talking-talks too much, too fast; changes topics too quickly; cannot be interrupted

• Distractibility-attention moves constantly from one thing to the next

• Hypersexuality-increased sexual thoughts, feelings or behaviors; use of explicit sexual language

• Increased goal-directed activity or physical agitation

• Disregard of risk-excessive involvement in risky behaviors or activities.

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Childhood Bipolar Disorder

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• Abnormal mood (anger or sadness) at least half of the day, most days and noticeable to teachers, parents and peers.

• Hyperarousal defined by at least three (insomnia, agitation, distractibility, racing thoughts, flight of ideas, pressured speech and intrusiveness).

• Atypical increase in reactivity to negative emotional stimuli, either verbal or behavioral (extended age-appropriate temper tantrums, rages and aggression toward others or property).

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