Certain types of depression vary in gravity and have links to specific events and individuals. Seasonal affective disorder is due to changes in season and may result from a lack of sunlight. Postpartum depression occurs in women who have recently had a baby. Other types of depression are more serious such as major depression, which can affect the body and mind in an often negative way. Statistically depressive symptoms are common in pediatric clinical settings, with 5 % to 10 % of children and adolescents presenting with subsyndrom symptoms of major depressive disorder (MDD). 11 MDD is estimated to affect 2 % of children aged 6 to 12 years and 4 % to 8 % of adolescents aged 13 to 17 years. In children, the ratio of boys to girls is 1:1, but in teens, the ratio changes to 1:2. Dysthymic disorder (DD), which constitutes a more chronic, milder form of depression, has been reported to afflict 0,6 % to 1,7 % of children and 1,6 % to 8 % of adolescents. The risk of depression increases significantly after puberty (particularly in girls), and by age 18, the cumulative incidence is 20 %.
Since the discovery of first antidepressants (monoamine oxidase inhibitors) a half century passed. There are now almost two-dozen antidepressant agents that work by nine distinct pharmacological mechanisms at the receptor level. However, opposite to the divergence in their pharmacological mechanisms at the receptor level, antidepressant drugs probably stimulate similar pathways in subcellular level. These subcellular events or so called beyond receptor effects are named neuroplasticity, and the mechanism may be called as adaptation. These after-receptor processes, through their effects on synaptic transmission, and gene expression are indeed capable of altering many molecular events in the brain. In this article, the mechanisms of actions of antidepressants at- and beyond- the receptors are discussed by documenting some of the evidence indicating such long-term alterations. Accordingly, the well-known effects of antidepressants on the receptor level are initiating events of antidepressant drug action, which enhance and prolong the actions of norepinephrine and/or serotonin and/or dopamine. Only if an adequate dose of an antidepressant is taken chronically, the increase in the synaptic norepinephrine and/or serotonin and/or dopamine stresses or perturbs the nervous system and the therapeutic response results from the adaptations that occur as a consequence of these chronic perturbations.
Depression and suicidality in youth are significant public health issues. Prevention strategies targeting at risk youth have demonstrated greater success than interventions applied universally, suggesting a role for routine screening of depression in primary care settings. Fluoxetine and, most recently, escitalopram have accumulated adequate efficacy and safety data to merit FDA-approved indication for the treatment of pediatric depression. The psychotherapeutic treatments shown to be most effective for adolescent depression include CBT and IPT-A. While there have been few empirical studies on the treatment of suicidal behavior among adolescents, the current data suggest that reduced suicidality is associated with successful treatment of depression. When contemplating the risks and benefits of the various treatments, one must also consider the risks on non treatment, which are likely to be substantial for routine screening of depression in primary care settings. Fluoxetine and, most recently, escitalopram have accumulated adequate efficacy and safety data to merit FDA-approved indication for the treatment of pediatric depression. The psychotherapeutic treatments shown to be most effective for adolescent depression include CBT and IPT-A.