13.6 Depression

Question 1

Depression and Suicide

Answer 1

• This issue is very underdiagnosed because depression in childhood is difficult to detect due to children and adolescents not being good at expressing their feelings appropriately. They tend to act out their problems instead of identifying them verbally. Children who can’t verbalize their depression may exhibit IRRITABILITY which can manifest as frustration, temper tantrums, behavioral problems.
• Screenings are incredibly important, and it is done at every routine healthcare visit

Adolescent Screenings
- Declining school grades
- Chronic melancholy
- Family dysfunction
- Alcohol/Drug use
- Gay, lesbian, bisexual
- History of abuse
- Previous suicide attempts

• SUICIDAL PATIENTS NEED IMMEDIATE REFERRAL FOR ACUTE INTERVENTION

Question 2

Columbia Depression Screening

Answer 2

• Used for children 12+

FACTS
F - Feelings
A - Actions
C - Changes
T - Threats
S - Situation

• Checks for warning signs of suicide
• Asking a person about suicide does not cause a person to be suicidal that wasn’t previously suicidal.
• If a patient is admitted with depression/suicidal thoughts, multiple times a shift we need to assess how they are feeling, if they have thoughts of suicide, and if they have a plan.
• THERE IS NO CONFIDENTIALITY BECAUSE THEY ARE A THREAT TO EITHER THEMSELVES OR SOMEONE ELSE WITH SUICIDE.

Question 3

Depression Symptoms

Answer 3

Behavior
- Sad facial expressions with diminished range of affective response
- Solitary play or work, tendency to be alone
- Withdrawal from previously enjoyed activities
- Lower grades in school and lack of interest
- Diminished motor activity (tired)
- Tearfulness or crying
- Dependent, clinging, aggressive/disruptive behavior

Internal States
- Low self esteem, hopelessness, guilt
- Suicidal Ideations

Physiologic Manifestations
- Constipation
- Non-specific complaints of not feeling well
- Change in appetite with weight gain/loss
- Alterations in sleep pattern (no sleep or sleeping too much)

Question 4

Depression Treatment

Answer 4

• Multidisciplinary team (psychology, pediatrics, nursing, social work, child life)

Mild-to-Moderate-to-Severe

Mild-to-Moderate
- Preferred treatment is psychosocial therapy (cognitive behavioral therapy)
- Antidepressants can also be used but this is usually reserved for moderate-to-severe.

Medications
- Tricyclics and SSRIs
- Fluoxetine is the first choice for 8+ y/o
- SSRIs (black box warning that can increase suicidal ideation because giving patients more energy can give them the energy they need to go through with suicide)

SIDE EFFETS
- Serotonin Syndrome
- Agitation, Muscle Twitching, Gastric Upset, Chills, Fever, Confusion, Dizziness

Question 5

How to Respond

Answer 5

• If a patient is actively suicidal and you have immediate concern of safety, YOU MUST HELP (call 911 or report active suicide ideations)

Question 6

Self Mutilation

Answer 6

• Children with depressive disorders who purposefully harm themselves without intent of killing themselves

Question 7

Suicidal Ideations

Answer 7

• Implement suicide precautions and prompt referral to the emergency department