What is the best measure of depression severity in adolescents?

At present the key symptom for diagnosing major depressive disorder (MDD) in adolescents is irritability. However a new study has found that the severity of anhedonia (the inability to gain pleasure from experiences that usually are enjoyable) rather than of irritability is associated with more severe MDD and worse clinical outcomes and suicide scores. Results of the study are published in Journal of Child and Adolescent Psychopharmacology (JCAP), and is available free on the JCAP website until April 30, 2015.

Vilma Gabbay, MD, and coauthors at Icahn School of Medicine at Mount Sinai and New York University Langone Medical Center (New York, NY), and Nathan S. Kline Institute for Psychiatric Research (Orangeburg, NY), used a quantitative approach to focus on symptoms of irritability and anhedonia simultaneously in 90 adolescents with MDD. Only anhedonia severity showed a significant correlation with the severity of overall outcomes, including illness severity, episode duration, and number of MDD episodes. In the article "Anhedonia, but not Irritability Is Associated with Illness Severity Outcomes in Adolescent Major Depression," the authors emphasize the importance of closely monitoring highly anhedonic depressed adolescents.

"This is a pivotal study of the critical aspects of adolescent depression," says Harold S. Koplewicz, MD, Editor-in-Chief of Journal of Child and Adolescent Psychopharmacology and President of the Child Mind Institute in New York. "The authors provide us with an insight that has significant implications for early intervention and effective treatment. Their work also reinforces the need for targeted studies of this disease in the adolescent population if we want to understand it and mitigate its harmful effects on youth."