Prognosis
Childhood depression, like depression in adulthood, is a chronic and recurrent illness that causes significant morbidity and mortality. A major depressive episode may remit spontaneously (even without treatment) within 1 to 2 years, but may last up to 9 months in clinical samples.[91] About 50% to 60% of young people respond to the first psychotherapy or medication treatment that was tried. An additional 40% and 50% of young people who do not respond to at least one medication trial respond when switching to a new antidepressant, or switching to a new antidepressant plus psychotherapy.[127] However, once improved, the relapse or recurrence rate is high. Following recovery from a depressive episode, it is estimated that about 40% of young people have a relapse of the index episode, or a recurrence (new episode) of a major depressive episode within 2 years after remission, and up to 70% at 5 years after remission. Depressed young people spend up to 30% of their lives in a depressive episode, which causes significant impairment in academic and social functioning and increases the risk for suicide and substance use disorders.[66] One UK-based cohort study (n=3884) found that the presence of severe affective symptoms in adolescents (both anxiety and depressive symptoms) was associated with an increased risk of premature mortality over a 53-year follow-up period. (In the study, affective symptoms were rated by teachers using a rating scale that pre-dated the introduction of diagnostic criteria.)[173] As such, it is critically important for clinicians to identify the presence of depression, and associated comorbidities, and to begin evidence-based treatment as early as possible.
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