Major Depressive Disorder

Depression is a serious mental health problem that causes significant deterioration in a person’s emotional state, thought structure, and physical health. Depression is a frequently seen mental disorder in children and adolescents. If the mother or father has depression, the likelihood of it occurring in the child also increases. Depression emerges through an interaction of genetic and environmental factors. Factors such as the presence of depression and bipolar disorder in the family, female gender, the unique difficulties of the adolescent period, the presence of another mental illness, chronic diseases, anxious or emotional temperament, negative thought structure, trauma and losses, neglect and abuse, exposure to bullying, negative parenting and conflicts with parents, and lack of social support increase the risk of depression.

If a child or adolescent appears sad, unhappy, restless, and depressed, does not enjoy situations or activities they previously enjoyed, has increased or decreased appetite, insomnia or excessive sleeping is observed, there is a decrease in restlessness and mobility, a decrease in energy, feels worthless or guilty, has difficulty focusing or remains indecisive, has low motivation, increased restlessness and irritability, social withdrawal, feelings of loneliness, finds life meaningless, or self-harm thoughts or attempts are observed, depression should be suspected.

The diagnosis is made through history obtained from multiple sources and a detailed psychiatric evaluation. Clinical evaluation scales are used as an aid in making the diagnosis. When necessary, psychological tests may be requested to support the diagnosis.

When evaluating a child with depression, accompanying mental problems, the child’s relationship with the parents, and social and academic skills must be assessed. Alcohol and substance use, bullying, abuse, self-harm, and suicidal thoughts must be directly questioned.

The likelihood of another mental problem accompanying depression is very high. In some studies, this rate has been found to be in the 60-80% range. Anxiety disorders most frequently accompany depression.

In mild to moderate depression in children and adolescents, psychological interventions should be considered as first-line treatment. Supportive therapy, group therapies, cognitive behavioral therapy, or follow-up with only individual counseling can be applied. If there is no response to interventions, if they are not appropriate, or if they are not easily accessible, medication treatment may be given. In the presence of moderate depression, antidepressant medication treatment combined with therapy may be initiated. In severe depression, therapy and medication treatment should be given simultaneously. In very severe depression and in the presence of suicide risk, inpatient treatment may be required. As therapy methods, play therapy is more preferred in younger children, while cognitive behavioral therapy and group therapy are more preferred in older children and adolescents.