Definition	Compared with adult depression, depression in children (six to 12 years of age) and adolescents (13 to 18 years of age) may have a more insidious onset, may be characterized more by irritability than sadness, and occurs more often in association with other conditions such as anxiety, conduct disorder, hyperkinesis, and learning problems.1
Incidence/Prevalence	Estimates of prevalence of depression among children and adolescents in the community range from 2 to 6 percent.2,3 Prevalence tends to increase with age, with a sharp rise around onset of puberty. Preadolescent boys and girls are affected equally, but depression is seen more frequently among adolescent girls than boys.4
Etiology/Risk Factors	The etiology is uncertain, but may include childhood events and current psychosocial adversity.
Prognosis	In children and adolescents, the recurrence rate of depressive episodes first occurring in childhood or adolescence is 70 percent by five years, which is similar to the recurrence rate in adults, but it is not clear if this is related to severity of depression.4 Young people experiencing a moderate to severe depressive episode may be more likely than adults to have a manic episode within the next few years.4,5 Trials of treatment for child and adolescent depression have found high rates of spontaneous remission (as much as two thirds of people in some inpatient studies).
Clinical Aim	To improve mood, social and occupational functioning, and quality of life; to reduce morbidity and mortality; to prevent recurrence of depressive disorder; and to minimize adverse effects of treatment.
Clinical Outcomes	In children and adolescents, there are developmentally specific pseudocontinuous self-report measures such as the Children's Depression Rating Scale and the Children's Depression Inventory, although some studies of adolescents use scales developed for use in adults such as the Hamilton Rating Scale for Depression. Parent-report pseudocontinuous measures such as the Children's Depression Inventory for Parents are also used. Categorical outcomes are sometimes expressed as people no longer meeting specified criteria for depression on a structured psychiatric interview such as the Kiddie-Shipman Anxiety Depression Scale, which combines data from children and their parents. Global improvement in symptoms as judged by an investigator is sometimes reported using the Clinical Global Impressions scale or the Clinical Global Assessment scale. Severity of depression is defined in some studies using cut-off scores on pseudocontinuous measures, such as the Children's Depression Rating Scale and the Children's Depression Inventory, but is often not stated.