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
