This chapter reviews the developmental epidemiology, and determinants of course and outcome of pediatric depression. Early-onset depression conveys significantly increased risk, compared to later-onset depression for the development of bipolar spectrum disorder. Parents have a right to know the goals and progress of treatment. A high proportion of clinically referred youth with mood disorders have clinically significant suicidal ideation or behavior. Multi-family psychoeducation and family-based attachment therapy show promise in randomized clinical trials. Two selective serotonin reuptake inhibitors, fluoxetine and escitalopram are approved for use in adolescent depression by the Federal Drug Administration (FDA); fluoxetine is also approved for use in preadolescent patients. Patients with co-morbid anxiety or obsessive compulsive disorder (OCD) can usually be treated with the same antidepressant as that used for the depression, although higher dosages may be needed to treat anxiety or OCD.