by Perlea, Victor ¹, Mayer, Gwendolyn ¹

• ¹ Universitätsklinikum Heidelberg

This is the extended version, for the abridged version click here
The introduction and overview can be found here

Disclaimer:We have compiled this information to the best of our knowledge based on current scientific literature (as of May 2026). However, we do not provide diagnosis or treatment recommendations. If you notice any mental health concerns in yourself or in a child or adolescent in your care, please consult a medical doctor.

Diagnostic criteria

• According to the DSM-5 and ICD-11, depressive disorders are characterized by persistent depressed or irritable mood and/or markedly diminished interest or pleasure, most of the day, nearly every day, for at least 2 weeks with associated symptoms such as sleep and appetite change, low energy, poor concentration, guilt, and suicidal thoughts (APA, 2013).
  
• Symptoms cause clinically significant distress or impairment and are not attributable to substances, medical conditions, or bereavement alone (Patel et al., 2016).
  
• Depressive disorders can emerge early, but presentation varies by developmental stage: While children often show more somatic symptoms (e.g., sleep/appetite changes), irritability rather than sadness, and behavioural withdrawal, adolescents tend to exhibit classic depressive symptoms (low mood, anhedonia), cognitive distortions, and increased risk for suicidality (APA, 2013).
  
• Early-onset depression is strongly associated with higher recurrence, chronicity, and increased risk for other mental health problems (APA, 2013).

Prevention measures

• Universal prevention includes teaching general stress-management and problem-solving skills (e.g., coping with school stress or social stress) to strengthen resilience in children/adolescents as well as relaxation methods and psychoeducation about mental health, emotions, and coping strategies. These should be implemented in school settings: Patel et al., 2016; Schulte-Körne (2018): https://www.bayerisches-aerzteblatt.de/fileadmin/aerzteblatt/ausgaben/2018/04/einzelpdf/BAB_4_2018_190_193.pdf
  
• Selected prevention targeting risk groups include the identification of high-risk children/adolescents (e.g., children whose parents suffer from depression) focus on modifying risk factors (e.g. improving parent–child interaction, enhancing coping skills, and reducing stressors within the family). Schulte-Körne (2018).
  
• Targeted interventions should be deployed to children/adolescents already showing subclinical symptoms, or with elevated vulnerability (e.g., family stress, parental depression). Schulte-Körne (2018).

Risk factors

• Family history of depression or bipolar disorder; previous depressive episodes or anxiety; chronic illness; history of abuse, bullying, or loss (Ernstmayer et al., 2022, Schulte-Körne, 2018).
  
• Minority stress, discrimination, and academic or social stressors; comorbid ADHD or substance use (Ernstmayer et al., 2022).

Treatment approaches

• Psychotherapy as first-line treatment with flexible treatment settings (individual, group, or family formats according to age group, developmental level, family context and severity of symptoms) including psychoeducation (for both youth and caregivers): Schulte-Körne et al., 2023: https://doi.org/10.1007/s00103-023-03721-4
  
• For some children/adolescents (especially older ones), antidepressant medication (typically SSRIs such as fluoxetine) may be considered — with close monitoring of suicidality and side effects: Hetrick et al., 2021: https://doi.org/10.1002/14651858.CD013674.pub2; Schulte-Körne et al. (2023)
  
• For moderate or severe depression, recurrent episodes, or risk of relapse, a combination of psychotherapy and medication may yield better outcomes than either alone. Pharmacotherapy is especially considered for moderate to severe depression, persistent or recurrent episodes, or when psychotherapy alone is insufficient: Dolle & Schulte-Körne (2013): https://doi.org/10.3238/arztebl.2013.0854
  
• Physical activity as complementary intervention (Schulte-Körne et al., 2023).

References for this article are here