Developmental aspects of depressive disorders

Strongly depending from developmental aspects, depressive disorders present with various symptoms. Whereas children often suffer from somatic concerns, adolescents rather appear irritated and tense which is not in line with ICD-10 criteria. Thus, age specific diagnostic procedures are warranted. Empirical data suggest cognitive-behavioral psychotherapy as well as interpersonal approaches as best evidence-based. Additional psychopharmacotherapy mostly is off-label in children and adolescents. The serotonin-reuptake inhibitor fluoxetine only is approved at the age of 8 for major depression and therefore is first choice in young patients. Sertraline and citalopram, respectively, are drugs of second choice. Informed consent of parents is imperative in minors. Therapeutic drug monitoring is recommended for optimising titration and minimising unwanted side effects. As for outcome, early-onset of depressive disorders, early comorbidity (conduct disorders), depressive mothers, separation of parents of children aged less than 10 years and social disintegration are negative factors.