Depression - Description

Page Contents

• Other Names
• ICD-9
• Description
• Genetics
• Prognosis
• Prevalence
• Pearls And Alerts
• Helpful Articles

Other Names

Major Depressive Disorder, Depression, Dysthymia

ICD-9

296, Major Depressive Disorder. Fourth and fifth digits required, see explanation below.

300.4, Dysthymic Disorder

311, Depressive Disorder NOS

296.90, Mood Disorder NOS

309.0, Adjustment Disorder with Depressed Mood

309.28, Adjustment Disorder with Mixed Anxious and Depressed Mood

Note that diagnosis and/or treatment of adjustment disorder may not be compensated if it is the only diagnosis.

Major Depressive Disorder is coded according to whether it is a single episode or recurrent. There is also a fifth digit specifiying severity, presence or absence of psychosis, and remission status.

• 296.2x Major Depressive Disorder, Single Episode; 296.3x Major Depressive Disorder, Recurrent
  • 5th digit specifiers : 1 - Mild; 2 - Moderate; 3 - Severe without Psychosis; 4 - Severe with Psychosis; 5 - In Partial Remission; 6 - In Full Remission; 0 - Unspecified

Click Depression ICD9 ( 66 KB) for more detail on ICD-9 coding.

Description

Depression is common, affecting up to 20% of youth by age 18. [Lewinsohn: 1998] A depressive disorder is diagnosed when a child or adolescent has a distinct change in mood to one that is persistently depressed, sad, or irritable and/or has loss of interest or pleasure lasting at least two weeks. The mood must differ from the patient’s baseline and the change in mood must affect social or school/occupational functioning.

Criteria for the diagnosis of Major Depression outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) [American: 2000] require additional symptoms including 5 or more of the following: sleep disturbance, appetite or weight disturbance, low energy, psychomotor slowing, poor concentration, guilt or shame, and suicidal thoughts or behavior. Proposed revisions and draft diagnostic criteria for a 5th Edition of DSM were released for public comment in February 2010, with planned publication in May 2013.

Depressive disorders in children and adolescents include:

• Major depressive disorder consists of one or more Major Depressive Episodes (two weeks or more of the symptoms described above). If mania or hypomania is present or has been present in the past, Major Depressive Disorder cannot be diagnosed (i.e. Bipolar Disorder excludes Major Depression).
• Dysthymic disorder consists of depressed mood on more than 50% of days for a period of at least one year. Dysthymia is less severe in terms of overall number of symptoms than Major Depression but, due to its chronicity, often results in greater dysfunction in social and school/occupational areas.
• Depressive disorder NOS is diagnosed in situations when a patient has depressed mood but does not meet full symptom or duration criteria for MDD or dysthymia. “Sub-syndromal” symptoms of depression (i.e., symptoms that do not meet the threshold for diagnosis of major depressive disorder) indicate increased risk (4-5 fold) for subsequent onset of a depressive disorder. [Fergusson: 2005] Certain symptoms (e.g., sad mood, irritability, low motivation) are of greater concern than others (e.g., appetite or weight disturbance, poor concentration) with regard to this increase in risk.

Bipolar depression is characterized by the presence of all of the symptom criteria for major depressive disorder and a history of mania or hypomania. Bipolar disorder often presents with symptoms of depression and is important to consider when evaluating a patient for a suspected depressive disorder. Many aspects of diagnosis and treatment of bipolar disorder are distinct from those of other depressive disorders. Suspected bipolar disorder is a strong criterion for referral to a child and adolescent psychiatrist.

Other variants of Major Depressive Disorder include Psychotic Depression and Atypical Depression. These are beyond the scope of this module but more information can be found under some of the links provided below.

Genetics

Multiple studies support a genetic component to depression. However, candidate genes are not well defined and a multifactorial etiology that may include environmental factors, is hypothesized.

Prognosis

Major depression is most often a recurrent illness, with up to 70% of affected youths experiencing recurrence within 5 years of an episode. [Birmaher: 2007] The likelihood of subsequent recurrence increases with each episode.

Prevalence

The prevalence of depressive disorders is 2% in prepubertal children and 4-8% after puberty. In prepubertal children, males and females are equally affected; after puberty, rates of depression are twice as high in females. [Birmaher: 2007] The Epidemiologic Catchment Area study suggested an increase in prevalence of childhood depression in successive birth cohorts. [Burke: 1991] However, subsequent studies have called this conclusion into question. [Murphy: 2000] A possible explanation for the apparent increase in prevalence is the use of retrospective study methods, which rely on the recall of individuals as to when their first episode of depression occurred. More recent cohorts have been asked to recall events from the more recent past, which may allow better recall of more and earlier depressive symptoms. Prospective studies of childhood depression show stable prevalence over time.

Pearls And Alerts

Helpful Articles

David-Ferdon C, Kaslow NJ.
Evidence-based psychosocial treatments for child and adolescent depression.
J Clin Child Adolesc Psychol. 2008;37(1):62-104. PubMed abstract
A concise review of evidence based psychosocial treatments (mainly psychotherapies) for depressive disorders in children and adolescents.

Zalsman G, Brent DA, Weersing VR.
Depressive disorders in childhood and adolescence: an overview: epidemiology, clinical manifestation and risk factors.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):827-41, vii. PubMed abstract

Zalsman G, Oquendo MA, Greenhill L, Goldberg PH, Kamali M, Martin A, Mann JJ.
Neurobiology of depression in children and adolescents.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):843-68, vii-viii. PubMed abstract

March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J.
Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial.
JAMA. 2004;292(7):807-20. PubMed abstract

Stalets MM, Luby JL.
Preschool depression.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):899-917, viii-ix. PubMed abstract

Angold A, Costello EJ.
Puberty and depression.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):919-37, ix. PubMed abstract

Weersing VR, Brent DA.
Cognitive behavioral therapy for depression in youth.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):939-57, ix. PubMed abstract

Klomek AB, Mufson L.
Interpersonal psychotherapy for depressed adolescents.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):959-75, ix. PubMed abstract

Moreno C, Roche AM, Greenhill LL.
Pharmacotherapy of child and adolescent depression.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):977-98, x. PubMed abstract

Apter A, King RA.
Management of the depressed, suicidal child or adolescent.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):999-1013, x. PubMed abstract

Brent DA, Birmaher B.
Treatment-resistant depression in adolescents: recognition and management.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):1015-34, x. PubMed abstract

Stein D, Weizman A, Bloch Y.
Electroconvulsive therapy and transcranial magnetic stimulation: can they be considered valid modalities in the treatment of pediatric mood disorders?.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):1035-56, xi. PubMed abstract

Kennard BD, Emslie GJ, Mayes TL, Hughes JL.
Relapse and recurrence in pediatric depression.
Child Adolesc Psychiatr Clin N Am. 2006;15(4):1057-79, xi. PubMed abstract

Hughes CW, Emslie GJ, Crismon ML, Posner K, Birmaher B, Ryan N, Jensen P, Curry J, Vitiello B, Lopez M, Shon SP, Pliszka SR, Trivedi MH.
Texas Children's Medication Algorithm Project: update from Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder.
J Am Acad Child Adolesc Psychiatry. 2007;46(6):667-86. PubMed abstract

Brent D, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller M, Vitiello B, Ritz L, Iyengar S, Abebe K, Birmaher B, Ryan N, Kennard B, Hughes C, DeBar L, McCracken J, Strober M, Suddath R, Spirito A, Leonard H, Melhem N, Porta G, Onorato M, Zelazny J.
Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial.
JAMA. 2008;299(8):901-13. PubMed abstract / Full Text

Depression Module Authors

The authors listed above are responsible for the overall Depression Module. Authors contributing to individual pages in the module are listed on those pages.

Page Bibliography

American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision).
4th edition (June 2000) ed. Washington, DC: American Psychiatric Association; 2000. 0890420254

Birmaher B, Brent D, Bernet W, Bukstein O, Walter H, Benson RS, Chrisman A, Farchione T, Greenhill L, Hamilton J, Keable H, Kinlan J, Schoettle U, Stock S, Ptakowski KK, Medicus J.
Practice parameter for the assessment and treatment of children and adolescents with depressive disorders.
J Am Acad Child Adolesc Psychiatry. 2007;46(11):1503-26. PubMed abstract
The most recent practice parameter on the diagnosis and treatment of depressive disorders in children and adolescents.

Burke KC, Burke JD Jr, Rae DS, Regier DA.
Comparing age at onset of major depression and other psychiatric disorders by birth cohorts in five US community populations.
Arch Gen Psychiatry. 1991;48(9):789-95. PubMed abstract

Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL.
Subthreshold depression in adolescence and mental health outcomes in adulthood.
Arch Gen Psychiatry. 2005;62(1):66-72. PubMed abstract

Lewinsohn PM, Rohde P, Seeley JR.
Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications.
Clin Psychol Rev. 1998;18(7):765-94. PubMed abstract

Murphy JM, Laird NM, Monson RR, Sobol AM, Leighton AH.
A 40-year perspective on the prevalence of depression: the Stirling County Study.
Arch Gen Psychiatry. 2000;57(3):209-15. PubMed abstract