Diagnostic Approach to Depressive Disorders

Clinical Assessment

The American Academy of Pediatrics recommends conducting direct interviews with patients and families/caregivers to establish symptom timeline and identify potential stressors, and employing standardized depression assessment tools (PHQ-9 or similar) to quantify symptom severity 1, 2
The assessment should include evaluating functional impairment across multiple domains: school/work, home, and peer/social settings, and answering critical diagnostic questions such as the presence of a clearly identifiable psychosocial stressor and the timing of symptom onset 1, 2
The assessment should also consider the patient's symptoms and determine if they represent an excessive or disproportionate response to the stressor, and if they are causing clinically significant distress or functional impairment 1, 2

The American Academy of Pediatrics suggests prioritizing treatment of the condition causing the greatest functional impairment when multiple diagnoses coexist, and addressing comorbid conditions (anxiety, personality features) that may affect treatment response 1, 3
Selective serotonin reuptake inhibitors (SSRIs) are appropriate first-line pharmacotherapy when full diagnostic criteria are met and functional impairment is significant, according to the Praxis Medical Insights guideline 3

The Praxis Medical Insights guideline recommends using standardized tools, such as PHQ-9 scores, for systematic monitoring of depressive symptom severity over time 3
The American Academy of Pediatrics suggests that clinical judgment is essential to determine whether the response to a stressor represents normal distress versus a disorder requiring treatment, and that standardized instruments aid diagnosis but cannot replace direct clinical interview 1, 2