Managing Depression in Youth

Graham J Emslie, MD, professor psychiatry and pediatrics, UT Southwestern Medical Center and Children's Medical Center, Dallas, Texas, answers questions about his 2021 Psych Congress session titled "Comprehensive Approaches for Managing Depression in Youth". His session explored recent research, measurement-based care, and strategies for preventing relapse and promoting wellness in youth with depression.

Question: What are some of the ways you are able to distinguish Depression from other mental health disorders in children and adolescents?

Answer: Clinical depression is evidenced by a pervasive disturbance in mood, which could be sadness or irritability, or loss of interest. This could be evidenced by a marked change in involvement in usual activities, schoolwork, and/or involvement with friends and family.  

Q: What percentage of children with Depression also have comorbid mental health disorders? And which are most commonly associated with Depression?

A: In clinically referred youth, rates of comorbid disorders are high, with approximately a third having concomitant anxiety and a third with ADHD. In depressed youth, anxiety disorders, and ADHD are the 2 most common comorbid conditions.

Q: Do you see a difference in different demographics in depression diagnoses?

A: Rates of depression in childhood are similar for males and females. However, beginning in adolescence, the rate of depression in females increases, and in young adults, the rate of depression in females is twice that of males. Pediatric depression is present in all ethnic groups but may present differently across cultures. Trauma and environmental stressors can contribute to depression. 

Q: Can you briefly address both pharmacological and non-pharmacological treatments for depression and how to identify when it may be time to introduce medication therapy?

A: Both psychotherapy and antidepressant medications are effective in treating pediatric depression.  For moderate to severe depression, it’s reasonable to treat with either specific psychotherapy or antidepressant medication or a combination of both.

Graham J Emslie, MD, joined the UT Southwestern Faculty in 1981. He is a Professor of Psychiatry and Pediatrics and holds the Charles E. and Sarah M. Seay Chair of Child Psychiatry at UT Southwestern Medical Center and Children’s Health, Children’s Medical Center. Dr Emslie has served as director for both the inpatient and outpatient units of Children’s Medical Center’s Psychiatry Division. Currently, he is continuing his work in the research and treatment of child and adolescent depression and suicide.

Dr Emslie’s research foci are in the areas of conducting efficacy and effectiveness trials with medications and psychotherapy for children and adolescents with depression, anxiety disorders, and attention-deficit disorder. He is also involved with developing and evaluating medication algorithm protocols for children and adolescents with depression.