Things to know about depression in children

Depression in children can be caused by a number of biological, psychological, and environmental risk factors. Signs of depression in children can include a depressed or irritable mood or loss of interest or pleasure, and other clinical signs.
Depression in children can be caused by a number of biological, psychological, and environmental risk factors. Signs of depression in children can include a depressed or irritable mood or loss of interest or pleasure, and other clinical signs.

  • Depressionis a condition that is more severe than normal sadness and can significantly interfere with a child's ability to function.
  • Depressionaffects about 2% of preschool and school-age children.
  • Depressionin children does not have one specific cause but rather a number of biological, psychological, and environmental risk factors that are part of its development.
  • General symptoms ofdepression, regardless of age, including having adepressedor irritable mood or loss of interest or pleasure for at least two weeks and having at least five clinical signs and symptoms.
  • Suicideis the third leading cause of death in young people 10-24 years of age.
  • To diagnose depression, a health care professional will likely perform or refer for a thorough medical assessment and physical examination and ask standard他的精神althquestions.
  • Treatment for childhood depression may include addressing any medical conditions that caused or worsened the condition. It can also involve lifestyle adjustments,psychotherapy, and, for moderate to severe depression, medication.
  • 人际关系治疗(ITP) andcognitive behavioral therapy(CBT) are the major approaches commonly used to treat childhood depression.
  • About 60% of children who takeantidepressantmedication improve. It may take up to six weeks of treatment with medication at its effective dose to start improving.
  • Childhood depression is a risk factor for developing a number of other mental health symptoms and disorders.
  • 抑郁症是残疾的主要原因在the United States in people over 5 years of age.
  • Preventionof childhood depression seeks to reduce risk factors and strengthen protective factors using approaches that are appropriate for the child's developmental level.
  • It is advisable for family members and friends to seek mental health assessment and treatment for the depressed child.

Childhood Depression Symptoms

Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. Depressive disorders are characterized by pervasive mood changes that affect all aspects of an individual's daily functioning.

Symptoms of depression also include

  • helplessness,
  • guilt,
  • feelings of worthlessness,
  • hopelessness,
  • loss of energy,
  • loss of appetite,
  • lack of interest in daily activities,
  • irritability,
  • sleep problems,
  • self-loathing,
  • thoughts of suicide.

What is childhood depression?

  • Clinically significant depression is severe enough to interfere with one's ability to function.
  • It is quite common at every age, affecting more than 16% of children in the United States at some time in their lives, and is thought to be increasing in children and adolescents, both in this country and elsewhere.
  • Other statistics about depression include its tendency to occur at a rate of about 2% before the teenage years and at approximately 5%-8% when both adolescents and children younger than adolescence are considered.
  • It is a leading cause of health impairment (morbidity) and death (mortality).
  • About 3,000 adolescents and young adults die bysuicideeach year in the United States, making it the third leading cause of death in people 10-24 years of age.

What are the types of depression in children?

  • Children may suffer from episodes of moderate to severe depression associated with major depressive disorder, or more chronic, mild to the moderate low mood ofdysthymia
  • Depression may also be part of other mood disorders likebipolar disorder, as aresult of psychosis (for example, having symptoms ofdelusionsorhallucinations), as part of a medical condition likehypothyroidism, or the result of exposure to certain medications such ascoldmedications ordrug abuse, likecocainewithdrawal.

QUESTION

Depression is a(n) __________ .See Answer

What arecausesand risk factors for depression in children?

  • Depressive disorders in children do not have one specific cause. Rather, people with these conditions tend to have a number of biological, psychological, and environmental contributors to their development.
  • Biologically, depression is associated with a deficient level of the neurotransmitter serotonin in the brain, a smaller size of some areas of the brain, and increased activity in other parts of the brain.
  • Girls are more likely to be given the diagnosis of depression than boys, but that is thought to be due to, among other things, biological differences based on gender, and differences in how girls are encouraged to interpret their experiences and respond to them as opposed to boys.
  • There is thought to be at least a partial genetic component to the pattern of children, andteenswith a depressed parent are as much as four times more likely to also develop the disorder.
  • Children who have depression oranxietyare more prone to have other biological problems, like low birth weight, suffering from a physical condition, trouble sleeping, and having a mother younger than 18 years old at the time of their birth.
  • Psychological contributors to depression include
    • low self-esteem,
    • negative social skills,
    • negativebody image,
    • being excessively self-critical, and
    • often feeling helpless when dealing with negative events.
  • Children who suffer from conduct disorder,注意缺陷多动障碍(ADHD), clinicalanxiety, or who have cognitive or learning problems, as well as trouble engaging in social activities, also have more risk of developing depression.
  • Depression may be a reaction to life stresses, liketrauma, including
    • verbal, physical, or sexual abuse,
    • the death of a loved one,
    • school problems,
    • bullying, or
    • suffering from peer pressure.
  • Youth who are struggling to adapt to the United States culture has found to be at higher risk for developing depression.
  • Research differs as to whetherobese儿童发展depr的风险增加ession.
  • Other contributors to this condition include
    • poverty and financial difficulties in general,
    • exposure to violence,
    • social isolation,
    • parental conflict,
    • divorce, and
    • 其他原因的disruptions to family life.
  • Children who have limited physical activity, poor school performance, or lose a relationship are at higher risk for developing depression, as well.

What are the symptoms and warning signs of depression in children?

Clinical depression, also calledmajor depression, is more than sadness that lasts for a day or two. In true depressive illnesses, the symptoms last weeks, months, or sometimes years if not treated.

抑郁往往导致una的患者ble to perform daily activities, such as getting out of bed or getting dressed, performing well at school, or playing with peers.

General symptoms of a major depressive episode, regardless of age, including having a depressed mood or irritability or difficulty experiencing pleasure for at least two weeks and having at least five of the following signs and symptoms:

  • Feeling sad or blue and/or irritable or seeming that way as observed by others (for example, tearfulness or otherwise looking persistently sad, or angry)
  • Significant appetite changes, with or without significantweight loss, failing to gain weight appropriately, or gaining excessive weight
  • Change insleeppattern: trouble sleeping or sleeping too much
  • Physicalagitationor retardation (for example, restlessness or feeling slowed down)
  • Fatigueor low energy/loss of energy
  • Difficulty concentrating
  • Feeling worthless, excessively guilty, or tending to self-blame
  • Thoughts of death or suicide

Children with depression may also experience the classic symptoms but may exhibit other symptoms as well, including

  • impaired performance of schoolwork,
  • persistent boredom,
  • quickness to anger,
  • frequent physical complaints, likeheadachesand stomachaches,
  • more risk-taking behaviors and/or showing less concern for their own safety.

Examples of risk-taking behaviors in children include unsafe play, like climbing excessively high orrunningin the street.

Parents of infants and children with depression often report noticing the following behavior changes in the child:

  • Crying more often or more easily
  • Increased sensitivity to criticism or other negative experiences
  • More irritable mood than usual or compared to others their age and gender, leading to vocal or physical outbursts, defiant, destructive, angry, or other acting out behaviors
  • Eating patterns, sleeping patterns, or significant increase or decrease in weight change, or the child fails to achieve appropriate gain weight for their age
  • Unexplained physical complaints (for example,headachesorabdominal pain)
  • Social withdrawal, in that the youth spends more time alone, away from friends and family
  • Developing more "clinginess" and more dependent on certain relationships (This is not as common as social withdrawal.)
  • Overly pessimistic, hopeless, helpless, excessively guilty, or feeling worthless
  • Expressing thoughts about hurting him or herself or engaging in self-injury (like cutting or burning him or herself), reckless or other potentially harmful behavior
  • Young children may act younger than their age or than they had before (regress).

SLIDESHOW

Learn to Spot Depression: Symptoms, Warning Signs, MedicationSee Slideshow

How do health care professionals diagnose depression in children? What health care specialists diagnose and treat childhood depression?

  • Many healthcare providers can help determine if the diagnosis of clinical depression is appropriate in children, including licensed mental health counselors, pediatricians, other primary care providers, specialists seen for a medical problem, emergency room doctors, psychiatrists, psychologists, psychiatric nurses, nurse practitioners, physician assistants, and social workers.
  • Due to the societal stigma that can be associated with receiving mental health treatment, pediatricians and other primary care doctors are often the first professionals approached for diagnosis and treatment of depression.
  • The practitioner consulted to assess a child for depression will likely perform or refer for a thorough medical interview and physical examination as part of assigning the correct diagnosis.
  • Depression is associated with a number of other mental health conditions, like注意缺陷多动障碍(ADHD),autismspectrum disorders,bipolar disorder,posttraumatic stress disorder(PTSD),obsessive-compulsive disorder(OCD), andanxiety障碍,因此评估者可能会屏幕signs and symptoms ofmanicdepression (bipolar disorder), a history of trauma, and other mental health symptoms.
  • Childhood depression also may be associated with a number of medical problems, or it can be a side effect of various medications, exposure todrugsof abuse, or other toxins. Therefore, healthcare professionals often perform routine laboratory tests during the initial assessment to rule out other causes of symptoms.
  • Sometimes, it may be necessary to perform an X-ray, scan, or another imaging study. As part of the evaluation, the sufferer may be asked a series of questions from a standardized questionnaire or self-test to help determine the risk of depression and suicide.

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What should parents do if they suspect that their child is depressed?

  • Family members and friends should seek mental health assessment and treatment for the depressed child.
  • Adult family members may confer with the child's primary care doctor or seek mental health services by contacting one of the resources indicated below.
  • Once the child with depression is receiving treatment, family members can promote good mental health by gently encouraging him or her to have a healthy lifestyle, including encouraging the child to maintain a healthydiet, including adequate water intake, get enoughsleep,exerciseregularly, remain socially active, and to engage in healthystress-management activities.
  • Research that analyzed the results of several studies (meta-analysis) has found that the positive impact ofexerciseon mood is even more than assumed due to its being part of a healthy lifestyle.
  • Parents and other loved ones can also be helpful to the depressed child by discouraging him or her from engaging in risky behaviors.

What is thetreatmentfor depression in children?

  • If it is determined that your child is suffering from clinical depression, the healthcare professional likely will recommend treatment.
  • Treatment options may include alleviating any medical condition that causes or worsens depression. For example, a person who has low levels ofthyroid hormonemight receive hormone replacement with levothyroxine (Synthroid).
  • Other aspects of treatment may include supportive therapy, like lifestyle and behavioral changes, psychotherapy, complementary treatments, and possibly medication for moderate to severe depression.
  • If symptoms are severe enough that treatment with medication is appropriate, symptoms tend to improve faster and for a longer period when medication is combined with psychotherapy.
  • Most mental health professionals will continue treatment of major depression for six months to a year to prevent a reoccurrence of symptoms.
  • Treatment for children with depression can have a significantly positive effect on the child's functioning with peers, family members, and at school.
  • Without treatment, symptoms tend to last much longer, may not improve, or may worsen. With treatment, the chances of recovery are significantly improved.

Psychotherapy

Psychotherapy ("talk therapy")is a kind of mental health counseling that entails working with a trained therapist to figure out ways to solve problems and cope with depression. It can be a powerfully effective intervention, even resulting in positive biochemical changes in the brain. Forbabies, music therapy and infantmassageare useful interventions.

Two major kinds of psychotherapy commonly treat childhood depression:interpersonal psychotherapy and cognitive behavioral therapy.In general, these forms of treatment take weeks to months to complete and has the goal of alleviating depressive symptoms.

More intensive psychotherapy may be needed for a longer period when treating very severe depression or for depression that is accompanied by other psychiatric symptoms.

人际关系治疗(IPT):This form of psychotherapy seeks to alleviate depressive symptoms by helping children with depression develop more effective skills for coping with their emotions and relationships. IPT uses two strategies to achieve those goals:

  • Educating the child, his or her parents, and other family members about the nature of depression: The therapist will reassure the child and his or her loved ones that depression is a common illness and that most people tend to improve with treatment.
  • Defining problems (such as abnormalgriefor interpersonal conflicts): The therapist can help the child set realistic goals for solving problems and work with him or her and the child's family using different treatment techniques to reach these goals.

Cognitive-behavioral therapy (CBT):This approach to psychotherapy helps to decrease depression and the likelihood it will come back by helping the child change his or her way of thinking about certain issues. In CBT, the therapist uses three techniques to achieve these goals.

  • Didactic component:This phase helps to establish positive expectations for treatment and promote the child's participation in treatment.
  • Cognitive component:This promotes identifying the thoughts and assumptions that play a role in the child's behaviors, especially those that may predispose the sufferer to be depressed.
  • Behavioral component:This uses behavior-modification methods to teach the child more effective ways of dealing with problems.

Medications

The most commonly used group ofantidepressant medications prescribed for children选择性5 -羟色胺再摄取抑制剂(党卫军吗RIs). SSRI medications influence the levels of serotonin in the brain.

对于许多处方专业人士,这些medications are the first choice because of the significant degree of effectiveness and safety of this group of medicines. Examples of these medications are listed here with the generic name first and the brand name in parentheses:

Only Prozac and Lexapro are approved by the Food and Drug Administration (FDA) to treat childhood depression and only in those 8 years of age and older for Prozac, and 12 years old and older for Lexapro. Any other medications used to treat this condition in children or using an antidepressant in younger children is therefore considered to be being used "off label." The use of Paxil has fallen out of favor due to its lack of consistent efficacy in the context of the risk of possible side effects.

Although FDA-approved for use in teenagers withschizophreniarather than for depression, atypical neuroleptic medications likearipiprazole(Abilify) andrisperidone(Risperdal) are sometimes prescribed in addition to an antidepressant in children who either suffer from severe depression, fail to improve after receiving a trial of an antidepressant in addition to, or instead of, an antidepressant in children who have bipolar disorder.

Doctors sometimes prescribe non-neuroleptic mood-stabilizer medications with an antidepressant to treat children with severe unipolar depression who do not improve after receiving trials of differentantidepressants.医生可能会考虑这些药物ddition to or instead of an antidepressant in children who suffer from bipolar disorder.

Examples of such non-neuroleptic mood stabilizers includedivalproexsodium (Depakote),carbamazepine(Tegretol), andlamotrigine(Lamictal). Of the non-neuroleptic mood stabilizers, lamotrigine (Lamictal) seems to be unique in its ability to treat unipolar depression effectively by itself as well as in addition to an antidepressant. However, only people 16 years of age or older use the drug due to potentially serious side effects.

Other antidepressant medications work differently than the commonly used SSRIs. Physicians may prescribe the following medications when SSRIs have not worked:

About 60% of children who take antidepressant medication improve. It may take anywhere from one to six weeks of taking medication at its effective dose to start feeling better. The prescribing professional will likely assess the depressed child who is receiving the medication again soon after it is started to determine if the medication is being well tolerated and if symptoms have begun to improve. If not, the doctor or other prescriber might adjust the dose of the medication or prescribe a different one.

After symptoms start to improve, the prescribing healthcare professional will likely encourage the parents of the depressed child to continue giving the medication for six months to a year because stopping the medication too soon may result in symptoms returning or worsening. Some people need to take the medication for longer to prevent the depression from returning. Stopping treatment abruptly may cause the depression to return or for withdrawal effects (discontinuation syndrome) to occur, depending on which medication the doctor prescribes.

Side effects of antidepressant medications vary significantly from drug to drug and from person to person.

  • Common side effects can includedry mouth,upset stomach,nausea,tremor,insomnia,blurred vision,constipation, anddizziness
  • In rare cases, some people of all ages become acutely more depressed when on the medication, even havingsuicidalor homicidal thoughts, and/or attempting or completing suicide or homicide. Children and teenagers are particularly vulnerable to this rare possibility. However, when considering this risk, it is imperative to consider the risk of the possible serious outcomes that can result from untreated depression.

Alternative treatments

People use a number ofnonprescription herbalsupplementslike St. John's wort anddietary supplementslikevitamin Cand B complexvitaminsas remedies for depression. There is little known about the safety, effectiveness, or appropriate doses of these remedies, despite their being taken by thousands of people around the world.

  • While some of the best-known alternative remedies continue to be studied to see how well they work, there remains little evidence that herbalsupplementseffectively treat moderate to severe clinical depression.
  • Medical professionals are often hesitant to recommend herbs or dietary supplements to treat depression, particularly in children, because the FDA doesn't regulate them (as prescription drugs are) to ensure their purity, quality, and effectiveness.

What are complications of depression in children?

  • Depression during childhood puts sufferers at risk of developing a number of other mental health issues.
  • Children with depression are also more likely to have poor academic performance and to engage inalcoholand otherdrug abuse
  • As adults, people who had depression during childhood and adolescence are at risk for having trouble maintaining employment, as well as family and other social disruptions during adulthood.

What is the prognosis for depression in children?

  • Depression can be chronic, in that 85% of people who have one episode of the disorder will have another one within 15 years of the first episode.
  • Depressed individuals exposed to trauma are less likely to respond to treatment with antidepressant medication than those who have not experienced trauma.
  • Young people with depression are more likely to develop a severemental illnessduring adulthood compared to children who do not suffer from depression.
  • 抑郁症是残疾的主要原因在the United States for people over 5 years of age, particularly for females.
  • Childhood depression is a risk factor for a number of potentially negative outcomes, like academic and interpersonal problems, as well as issues with drugs and attempting suicide, and engaging in other forms of self-harm.
  • Since early treatment of childhood depression improves the prognosis, improving access to care (including encouraging parents and other family members to seek mental health treatment for their child) promotes a better prognosis.

Is it possible to prevent depression in children?

  • For children, from infancy through the teenage years, strong, healthy parent-child attachment can help protect the child from developing depression.
  • Parental behaviors that tend to foster healthy attachment with their children involve consistent love and care, as well as attentive responsiveness to the child's needs, including age-appropriate steps toward the child's gradual independence.
  • Preventing depression in childhood tends to involve addressing risk factors, both specific and nonspecific, strengthening other protective factors, and using an appropriate approach for the child's developmental level.
  • Such programs often use cognitive-behavioral and/or interpersonal approaches, as well as family-based prevention strategies because research shows that these interventions are the most effective.
  • Protective factors for adolescent depression include involving supportive adults, strong family and peer relationships, healthy coping skills, and emotional regulation.
  • Children of depressed parents tend to be more resilient when the child is more able to focus on age-appropriate tasks in their lives and on their relationships, as well as being able to understand their parents' condition.
  • For depressed parents, their children seem to be less likely to develop the disorder when the parent is able to demonstrate a commitment toparentingand to relationships.

Where can families get information and support for childhood depression?

American Association of Suicidology
http://www.suicidology.org
202-237-2280

American Foundation for Suicide Prevention
http://www.afsp.org

The Jason Foundation
http://www.jasonfoundation.com

National Alliance for the Mentally Ill
2101 Wilson Boulevard Suite 300
Arlington, VA 22203
HelpLine: 800-950-NAMI (6264)
Or Text "NAMI" to 741741
http://www.nami.org/

National Institute of Mental Health
866-615-6464
http://www.nimh.nih.gov

National Suicide Prevention Hotline
800-SUICIDE (784-2433)
http://www.suicide.org

National Suicide Prevention Lifeline
800-273-TALK (8255)

Substance Abuseand Mental Health Services Administration (SAMHSA)
877-726-4727
http://www.samhsa.gov

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Medically Reviewed on10/11/2022
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