PRESENTATION AND COURSE OF MAJOR DEPRESSIVE DISORDER DURING CHILDHOODAND LATER YEARS OF THE LIFE-SPAN

Objective: To examine whether major depressive disorder (MDD) in child hood, adolescence, and adulthood represents essentially the same diagn ostic entity. Method: Recent publications on clinically referred patie nts with MDD that met certain selection criteria were examined to abst ract information on six phenomenological features of the disorder: epi sode number, symptom presentation, psychiatric comorbidity, recovery f rom the index episode, recurrence of MDD, and switch to bipolar illnes s. The studies included both inpatients and outpatients with an age ra nge of 6 to 80+ years. Results: Synthesizing the information across br oad age groups revealed that clinically referred depressed youths, com pared with adults and the elderly, are almost exclusively first-episod e probands, evidence comparable symptom pictures, have similar rates o f psychiatric comorbidity, recover somewhat faster from their index ep isode of MDD, have a similar recurrence rate, and are at greater risk for bipolar switch. Conclusions: MDD in clinically referred youths is similar in many regards to MDD in adults and the elderly. However, the findings that the risk of recurrent MDD among children approximates t he rate among adults but, on average, about 20 years earlier in their lives, and that youths with unipolar depression convert to bipolar ill ness more frequently than do adults, suggest that very early onset MDD is a particularly serious form of affective illness.