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Major depressive episodes are common, with a reported incidence by age 17 years as high as 18.2% for girls and 7.7% for boys. Pediatricians should play a critical role in the diagnosis, triage, and treatment of children with mood and affect disorders.Objectives After completing this article, readers should be able to 1. Understand that depressive and bipolar disorders are common.2. Know the differential diagnosis of depressive disorders.3. Be able to screen and assess for suicidal risk.4. Describe the role pediatricians play in the management of depressive and bipolar disorders.5. Know the basic pharmacology for major depressive disorder. AbstractDepressive disorders are common in children and adolescents, with estimates for depressive episodes as high as 18.2% for girls and 7.7% for boys by age 17 years, and are a major cause of morbidity and even mortality. The primary care pediatrician should be able to (1) diagnose depressive disorders and use standardized instruments;(2) ask about suicide, self-harm, homicide, substance use, mania, and psychosis; (3) triage the severity of illness; (4) be aware of the differential diagnosis, including normal development, other depressive disorders, bipolar disorders, and comorbid disorders, such as anxiety and substance use; (5) refer to evidenced-based psychotherapies; (6) prescribe firstline medications; and (7) provide ongoing coordination in a medical home. Pediatric bipolar disorders and the new disruptive mood dysregulation disorder (DMDD) diagnoses are controversial but not uncommon, with prevalence estimates ranging from 0.8% to 4.3% in children at various ages. Although the pediatrician is not likely to be prescribing medications for children with bipolar disorder and DMDD diagnoses, all clinicians should be familiar with common neuroleptics and other mood stabilizers, including important potential adverse effects. Basic management of depressive and bipolar disorders is an important skill for primary care pediatricians.

Psychiatrically referred youth with ASD suffer from multiple highly impairing psychiatric disorders that require combination pharmacotherapy. These findings highlight the need for further research to guide clinical decision-making and treatment.

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