Transcript Depression

Depression
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Objectives
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Background
• Prevalence rates for depression:
– 1% to 2% of prepubertal children
– 3% to 8% of adolescents.
• Depression and bipolar disorder equally
common in both sexes.
• Unipolar depressive disorders in teens more
common in girls than in boys (ratio of 3:1)
• Early onset of puberty in girls increases the risk
for depression.
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Clinical Features & When to
Consider Diagnosis
• Sad, irritable, or angry
– may present with school or behavioral
problems
• Somatic complaints
– headache, stomachache, muscle weakness,
decreased or increased appetite, fatigue,
insomnia, hypersomnia, or disturbed sleepwake cycles
• Self-injurious behaviors or suicidal ideation,
plan, and intent
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Identifying Risk Factors
Environmental
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Abuse or neglect
Parental substance abuse
Marital problems
Low socioeconomic status and education
level
• Loss of parent, sibling, or close friend
• Stress related to adolescent developmental
or issues of sexuality (eg, homosexuality)
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Identifying Risk Factors
Genetic
• Depressed parent contributes both genetic
vulnerability & emotional unavailability that
can contribute
– combination of adverse life events and the
presence of the shorter allelic form of the
serotonin transporter gene results in earlyonset depression
• Smaller prefrontal cortex and basal
ganglia in depressed individuals
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Identifying Risk Factors
• Medications
– glucocorticoids, immunosuppressives,
isotretinoin, antiviral agents
• Chronic illness
– such as cystic fibrosis, juvenile diabetes
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Diagnosis
The Basic Steps
• Are symptoms present?
• Evaluate child’s current level of functioning
relative to his or her baseline
• Any potential for self-injurious behavior, suicidal
ideation, or suicide attempt?
• History taken from:
– Patient
– Parents
– Others : teachers, counselors, or coaches.
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Diagnosis
Tools
• Children’s Depression Inventory (CDI)
– assesses the severity of depression in prepubertal
school-age children
• Mood and Feelings Questionnaire (MFQ)
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Adolescents
• Beck Depression Inventory (BDI) Reynolds
Adolescent Depression Scale (RADS-2)
Diagnosis
Tools
• The Guidelines for Adolescent Depression in
Primary Care (GLAD-PC) Toolkit
– Has child and parent report measures and scoring
instructions on their web site
http://www.thereachinstitute.org/files/documents/GLAD-PCToolkit.pdf
– This user-friendly online resource also includes
management flowcharts, scales, and educational
materials in English and Spanish as well as tracking
forms and information on billing
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Treatment
Pharmacological
• Currently, fluoxetine (Prozac)is the only
antidepressant approved by the FDA in children
and adolescents
– research studies have demonstrated efficacy of other
drugs such as citalopram, paroxetine, and sertraline
• Dosing of Fluoxetine
– Starting at 2.5 mg/day for prepubertal children
– 10 mg/day for older adolescents
– Most patients respond to fluoxetine at doses ranging from 20 to
80 mg/day
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Treatment
Pharmacological
• 2006 FDA meta-analysis of children and
adolescents taking SSRIs for depression
– found an increased risk of suicidality in those
patients treated with drugs versus those given
placebo.
• Subsequent meta-analysis including additional
studies revealed that those who benefited from
SSRI treatment outnumbered those who
became suicidal during SSRI treatment by a
ratio of 14:1.
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