• Depression rarely occurs in childhood.  The prevalence of major depression is about 1.8% in pre-pubertal children, and 3.5-5% in adolescents.  Girls are more prone than boys.
  

1. Suicidal thoughts
   
2. Anorexia
   
3. Agitation
   
4. Severe lack of energy
   

• Unknown causes
  
• There are three major factors: 1) some individuals are genetically predisposed, e.g., there might be "chemical imbalance" that causes depression without a precipitating factor; 2) stress induced, i.e., problems in school, divorce of parents; and 3) developmental problems, e.g., Abuse as a child, personality problems.
  
• Females and those with family history of depression are also at risk.
  

• History
  
• Diagnosing depression is based on clinical findings, and not necessarily on any specific tests.  However, tests maybe used to assist in evaluating the depth of depression, and to rule out other diseases.
  
• Psychological Evaluation Tests: The Children's Depression Inventory, Children's Depression Scale, Depression Self-Rating Scale for Children
  
• Tests may be done to rule out other diseases, such as CAT scan, MRI of the brain, and blood tests that detect a thyroid hormone.
  
• Measurement of physiologic and neuroendocrine dysfunctions
  
• Dexamethasone suppression tests
  
• Sleep electroencephalography (EEG)
  
• Antidepressants (see below) -- if trial therapy is responded to, then the diagnosis is generally confirmed.
  

- It is important that FDA guidelines and mfgr.'s guidelines be carefully considered when these medicines are being used for the pediatric age group.  With some medications, safety, and effectiveness in children has not been proven. With some medications, use in children below a certain age is not recommend by the mfgr.

• Seek treatment as soon as possible.  Depression is a medical illness just like other illnesses and there is no reason to suffer from it.  If your child has suicidal thoughts, he needs immediate emergency treatment -- it is a life-threatening emergency.
  

• Hypothyroidism
  
• Hyperthyroidism
  
• Medication reaction
  
• Schizophrenia
  
• Partial complex Seizures
  
• Delirium
  
• Organic brain syndrome
  
• Panic disorder