Depression is a condition characterized by pervasive sadness, irritability, or anhedonia, along with additional symptoms affecting concentration, motivation, neurovegetative symptoms, and suicidal thoughts or actions. It is common, with a point prevalence of 1-2% in preadolescents and 3-8% of adolescents, and recurrent, with around 30-70% of depressed adolescents experiencing a recurrence within 2 years. Since depression shows about 50% heritability, it arises from a confluence of genetic vulnerability interacting with life stressors, such as maltreatment, bereavement, parent-child discord, and peer victimization. Characteristics of youth that predispose to depression include fearfulness and anxiety, negative cognitive bias, rumination difficulty with emotion regulation, and low levels of positive affect and blunted response to reward. Neuroimaging studies are consistent with these views, showing limbic hyperactivation in response to negative emotional stimuli and parallel decreased prefrontal activation, as well as blunted striatal response to reward. Evidence-based treatments for depression include cognitive behavior therapy, interpersonal therapy, and selective serotonin reuptake inhibitors, with some, albeit not incontrovertible evidence that combination of cognitive therapy and antidepressants result in more complete and more rapid recovery. Continuation treatment with antidepressants during the first 6-12 months after symptomatic improvement has been shown to prevent depressive relapse, and both cognitive behavior and interpersonal therapies have been shown to prevent the onset of depression in at-risk youth. History of abuse, current parental depression, and comorbidity have been found to moderate treatment response. Future work should focus on accelerating initial treatment response, identifying biomarkers to predict response and occurrence of suicidal events, and identifying efficacious treatments for youth with a history of maltreatment, since there is evidence that such patients do not respond as well to standard treatment.
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