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Depression (PDQ®): Supportive care - Health Professional Information [NCI] - Pediatric Considerations for Depression

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A model of childhood affective disorders uses the following explicit criteria:[12]

  • Dysphoric mood (children younger than 6 years must also have a sad facial expression).
  • At least 4 of the following signs or symptoms present every day for a period of at least 2 weeks:
    • Appetite disturbance.
    • Insomnia or hypersomnia.
    • Psychomotor agitation or retardation.
    • Loss of interest or pleasure in usual activities (children younger than 6 years must also have signs of apathy).
    • Fatigue or loss of energy.
    • Feelings of worthlessness, self-reproach, or excessive, inappropriate guilt.
    • Diminished ability to think or concentrate.
    • Recurrent thoughts of death or suicide.

Management of Pediatric Depression

Treatment regimens implemented in childhood depression reflect theoretical models, etiology, and manifestations of the disorder.[1] Individual and group psychotherapy are commonly utilized as the primary treatment modality and are directed at helping the child to master his or her difficulties and to enable the child to develop in an optimal manner. Play therapy may be used as a means of exploring a younger child's view of himself or herself, the disease, and its treatment. The child needs to be helped from the beginning to explore and understand, at a level appropriate for his or her developmental age, the diagnosis of cancer and the treatments involved.[1]

Pharmacologic management

As is the case with depression in adult cancer patients, there are few, if any, revealing trials of antidepressants in children with cancer. One author described rapid clinical response to low doses (<2 mg/kg/d) of imipramine or amitriptyline for eight depressed children with cancer.[13][Level of evidence: III] Another author described the use of benzodiazepines such as lorazepam, diazepam, alprazolam, and clonazepam for the treatment of anxiety disorders. Trials of benzodiazepines should be short term. These drugs should be tapered slowly when they are discontinued.[14]

The combined use of tricyclic antidepressants and neuroleptics in the management of three children with severe symptoms of depression and anxiety has been reported. The children studied were in the terminal phases of their disease and were treated with a combination of low-dose amitriptyline and haloperidol. Levels of anxiety and depression were decreased, and this intervention allowed the patients and their families to deal with issues involved in death and dying.[15][Level of evidence: III]

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