Description

• Major depressive disorder (MDD) is a mood disorder characterized by sadness and/or irritable mood with impairment of functioning; abnormal psychological development; and a loss of self-worth, energy, and interest in typically pleasurable activities.
• Adolescents with depression are likely to suffer broad functional impairment across social, academic, family, and occupational domains, along with a high incidence of relapse and a high risk for substance abuse and other psychiatric comorbidity.

Epidemiology

• In 2022, 19.5% of US adolescents (ages 12 to 17 years) had a major depressive episode in the last year.
• The prevalence of depression in female adolescents is double that of male adolescents.

Etiology and Pathophysiology

• Early life adversities in the context of immune and brain abnormalities (blunted reward-related activity, altered volume of limbic brain regions, and white matter disruptions) are associated with increased risk of major depression.
• Neurobiologic changes (HPA axis overactivity, serotonergic modulation of emotional processing pathways, decreased dopaminergic reward processing) can contribute.
• External factors may contribute such as substance use, adverse childhood events, or inadequate social network.

Risk Factors

• Prior depressive episodes
• History of insomnia, anxiety disorders, attention deficit hyperactivity disorder (ADHD), high-functioning autism, early puberty in girls, chronic childhood illness, and/or learning disabilities
• Body dysmorphic disorder, dieting, and/or being overweight
• Increased screen time, particularly social media
• Female gender
• LGBTQ identified
• Substance use
• Low self-esteem, negative thinking, worry about school/grades
• Family history (having a parent or close relative with depression or bipolar)
• Academic difficulties, being bullied, witnessing violence, abuse, perceived discrimination, loss of a loved one, low socioeconomic status, poor family functioning, or low parental involvement

General Prevention

• Child and adolescent mental health may be improved by successfully treating maternal depression.
• Protective factors include:
  • Having positive social connections with family/peers
  • Participating in school and extracurricular activities
  • Avoiding cannabis, tobacco, and alcohol
  • Not dieting
  • Getting adequate sleep
  • Limiting social media
• The United States Preventive Services Task Force (USPSTF) recommends the screening of adolescents (12 to 18 years of age) for MDD with systems in place to ensure accurate diagnosis, appropriate treatment, and follow-up.

Commonly Associated Conditions

Generalized anxiety disorder, behavioral disorders, substance abuse, and eating disorders