Differences in the clinical characteristics of adolescent depressive disorders

Abstract

Our objective was to analyze differences in clinical characteristics and comorbidity between different types of adolescent depressive disorders. A sample of 218 consecutive adolescent (ages 13-19 years) psychiatric outpatients with depressive disorders was interviewed for DSM-IV Axis I and Axis II diagnoses. We obtained data by interviewing the adolescents themselves and collecting additional background information from the clinical records. Lifetime age of onset for depression, current episode duration, frequency of suicidal behavior, psychosocial impairment, and the number of current comorbid psychiatric disorders varied between adolescent depressive disorder categories. The type of co-occurring disorder was mainly consistent across depressive disorders. Minor depression and dysthymia (DY) presented as milder depressions, whereas bipolar depression (BPD) and double depression [DD; i.e., DY with superimposed major depressive disorder (MDD)] appeared as especially severe conditions. Only earlier lifetime onset distinguished recurrent MDD from first-episode MDD, and newly emergent MDD appeared to be as impairing as recurrent MDD. Adolescent depressive disorder categories differ in many clinically relevant aspects, with most differences reflecting a continuum of depression severity. Identification of bipolarity and the subgroup with DD seems especially warranted. First episode MDD should be considered as severe a disorder as recurring MDD.

Chronic depression: Update on classification and treatment

“…This last fi nding is consistent with previous evidence that chronic depression aggregates in families [2••]. Similarly, Karlsson and colleagues [10] found that double depression was associated with an earlier age at onset, longer duration of index episode, and greater comorbidity (especially with anxiety disorders) than MDD.…”

“…Almost by defi nition, double depression and chronic MDD are more severe than dysthymic disorder with respect to symptomatology and functional impairment; however, few consistent differences between forms of chronic depression have been reported on other variables [2••, 10,13]. Moreover, longitudinal studies indicate that almost all patients with dysthymic disorder eventually experience exacerbations that meet criteria for MDEs [7•], suggesting that dysthymia and double depression are different phases of the same disorder.…”

Differences in Characteristics and Treatment Received among Depressed Adolescent Psychiatric Outpatients with and without Co-Occuring Alcohol Misuse: A 1-Year Follow-Up Study

“…Almost all of the interviewed subjects ( N = 218) had an ongoing episode of either unipolar or bipolar depression at baseline evaluation and were recruited to the study. Adolescent who declined to participate were similar to the study subjects in terms of age, sex, and parental socioeconomic status while they tended to have lower BDI-21 (19.0 versus 21.0, z = −1.93,    df = 371,    P = .05) and lower GHQ-36 (21.0 versus 24.0, z = −1.98,    df = 367,    P = .05) median sum scores [3, 8]. …”

“…The screening and diagnostic procedure and the study population ( n = 218) of the ADS study have been described in more detail previously [3, 28]. In brief, of the 774 consecutive outpatients, 660 (85.3%) were considered eligible.…”

“…Depressive disorders are common among adolescents with an estimated point prevalence of about 3% to 8%, and with a lifetime prevalence of approximately 20% by the end of adolescence [1–3]. Among adolescents, excessive substance use often co-occurs with depressive illness [4], alcohol being the most common substance used among Finnish adolescent population [5, 6].…”