12: Depression Flashcards
Why are underdiagnosis and undertreatment problems with younger children?
Often present atypically (stomach aches) and will be seen by school nurse.
T/F Depression can be genetic.
True. Children with depressed parents have 3x the risk to be diagnosed, with peak incidence between 15-20. However, 1/3-1/2 of children develop depression in the absence of family hx.
What depression diagnosis was removed from DSM-5?
Depression related to adjustment situations and bereavement. Remaining ones are: major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, substance/medication-induced depressive disorder, and depressive disorder d/t another medical condition.
What is the only FDA approved medication for depression in children?
Prozac
What are the duration guidelines for med treatment for depression in children (3)?
- If no benefit after 4 weeks, consider another medication.
- If mild response, consider continuing for 10 weeks to optimize response.
- Duration of treatment up to 1 year (sometimes lifelong).
- Symptom-free for 3 months before decreasing dose
- Monitor closely - 40-50% relapse within 2 years
If history is used to diagnose depression, why must a PE be performed?
To differentiate among organic causes (anemia, chronic fatigue, eating disorder, etc.).
What is the typical length of time to treat depression pharmacologically in children?
Typically 6-9 months, but can be up to 1 year. Until child demonstrates normal mood level. Taper slowly.
How do school-age children present with depression (7)?
Able to verbalize, but don’t always:
- Irritability/anger
- Hyperactivity
- Difficulty handling feelings
- Frequent absences, school phobia
- Loss of interest
- Describing themselves in negative terms
- Feeling guilty about behaviors
Of children 9-17 years old, _____% have a diagnosable mental or addictive disorder.
21%
What are the DSM-5 criteria for diagnosis of dysthymia (persistent depressive disorder)?
An overwhelming, chronic state of depression that is present on most days for at least 2 years. Baseline mood is irritable or depressed. Must not have gone for more than 2 months without 2 of:
- Poor appetite/overeating
- Insomnia/hypersomnia
- Low energy
- Low self-esteem
- Difficulty making decisions
- Feelings of hopelessness
T/F Children and adolescents with mood disorders often present first with somatic complaints such as headaches.
True
6 manifestations of major depression in adolescents.
- Severe sadness
- Withdrawn behavior
- Boredom
- Low self-esteem
- Feeling helpless and hopeless
- Sense that there is no meaning in life
What is first-line pharm therapy for depression in children?
SSRIs. Most trials have not demonstrated great effectiveness. Reserve for major depression. Tricyclics are second line. They are rarely used d/t side effects.
Half of all lifetime mental disorders begin by age _____.
14
T/F Childhood depression is often only recognized after noticing difficulty in school and social functioning.
True
What is the management of depression (3)?
- Assess for suicide risk/plan
- Meds
- Counseling (refer…we are not counselors!)
How do toddlers present with depression (9)?
- Lack of energy
- Eagerness to please/clingy
- Separation problems
- Sadness
- Poor appetite/weight loss
- Sleep issues
- Regression
- Increased physical complaints
- Overall behavior problems
What are the DSM-5 criteria for diagnosis of major depressive disorder?
5 or more symptoms must be present in the same 2-week period and at least 1 symptom must be depressed mood or loss of interest/pleasure. Others:
- Weight change/appetite change
- Insomnia or hypersomnia
- Psychomotor agitation
- Fatigue/loss of energy
- Disturbed concentration or indecisiveness
- Recurrent thoughts of death, suicide, or suicide attempt
How do adolescents present with depression (6)?
- Decreased interest
- Withdrawal
- Hopelessness
- Changes in weight/appetite
- Changes in sleep patterns
- Substance abuse
What is the black box warning for SSRIs and some antidepressants?
Can increase suicidal ideations and attempts in those under 26.
T/F It is difficult to distinguish between depression and “normal” adolescent growth and development and it is the leading cause of suicidal behavior and suicide.
True. It is difficult to differentiate b/c adolescents have developmental transitions, temperamental manifestations, and irritable moods.
What acronym should be used at every child assessment to cover the important topics during history taking?
HEADSS Home Education/employment Activities Drugs Sexuality Suicide
Depression is twice as common in _____ by age 14.
Girls
What is the one classic study that looked at treatment of depression in adolescents?
Treatment for Adolescents with Depression (TADS) 2004
