Allen- Adolescent Depression

Question 1

Describe the global burden of depression.

Answer 1

Suicide rates will have increased by 60% in last 50 years in the developing world.
By 2020 depression will be the second most prevalent medical condition.
36% increase in mental illness across the globe since 1990.

Question 2

Describe the burden of depression and suicide in the US.

Answer 2

Rate of anti-depressant use rose by 400% between 1988 and 2008

Question 3

How many americans age 12 and over take anti-depressants? M/F more likely to take antidepressant?

Answer 3

1 in 10
F 2.5 times more likely
No difference in sex rates ages 12-17
Almost 1/4 of women 40-59 take ADs

Question 4

Who is most likely to use anti-depressants?

Answer 4

Whites more than other minorities
Females more than males
14% of americans taking AD have done so 10 yrs or longer

Question 5

What percentage of psychiatric medications are prescribed by primary care?

Answer 5

80%

Question 6

What is the second leading cause of death in individuals under 18?

Answer 6

Suicide

Question 7

What is the most at risk group for suicide in the US?

Answer 7

white males over age 54

Question 8

What is the most at risk American Indian group?

Answer 8

Youth 15-25 comprise 40% of all NA suicides

Question 9

What are the 4 major mood disorders?

Answer 9

Major Depressive disorder
Persistent Depressive Disorder
Bipolar 1 and 2
Disruptive Mood Dysregulation Disorder

Question 10

What are the key characteristics of Major Depressive Disorder?

Answer 10

Persistent sadness in children or adolescents
Loss of interest in activities once enjoyed
Change in appetite/body weight
Difficulty sleeping/oversleeping
Psychomotor agitation/retardation
Loss of energy
*Five or more sx must persist for 2 or more weeks and at least one must be one of the first two

Question 11

What are the key characteristics of Persistent Depressive Disorder?

Answer 11

Depressed mood for at least 2 years (1 yr in adolescents/children)  plus...
under/over eating
insomnia
low energy
low self esteem
poor concentration
hopelessness

Question 12

What is bipolar disorder?

Answer 12

major depressive episode plus severe changes in mood to either extremely irritable or overly silly and elated

Question 13

What is the difference between Bipolar 1 and 2?

Answer 13

1- mania 7 days

2- hypomania 4 days

Question 14

What is Disruptive Mood Dysregulation Disorder?

Answer 14

New diagnosis to distinguish children w/ mild DMDD from childhood onset bipolar.

Onset must be before age 10. (6-18)

• severe recurrent temper outbursts that are inconsistent w/ developmental age
• outbursts on average 3+ times /week
• persistent irritability/anger btwn outbursts

Question 15

What are some signs of adolescent depression?

Answer 15

Being bored

Alcohol/substance abuse

Question 16

What is the prevalence of adolescent depression?

Answer 16

5%

By age 14 girls are 2x more likely to experience major depression

Question 17

Adolescent depression often co-occurs w/ what disorders?

Answer 17

ADHD
Conduct disorder
Delinquency
Drug/alcohol
Anxiety
Eating Disorder

Question 18

What are risk factors for adolescent depression

Answer 18

limited social support
early parental loss
female
family history
abuse
unstable parenting

Question 19

What age group has the highest risk of depression?

Answer 19

9th graders

Question 20

SSRIs should be reserved for what types of depression? How long should tx be maintained?

Answer 20

Moderate- severe
Fluoxetine, citalopram and sertraline
*TCAs are contraindicated

1 year

Question 21

What are the 3 goals of CBT?

Answer 21

Challenge maladaptive beliefs
Enhance problem-solving abilities
Increase social competence

Question 22

What are the key points to optimize treatment for adolescents w/ depression?

Answer 22

1. Combined treatment of CBT and SSRI
2. Treating pts longer makes a big differenc ein overall benefit (6-9 months)

*Adding CBT to treatment enhances safety/minimizes suicidal ideation and treats emergent suicidal events

Question 23

What are predisposing adolescent risk factors for suicide?

Answer 23

PREVIOUS SUICIDE ATTEMPT
Psychiatric disorder
sexual/physical abuse
exposure to violent behavior
family history of suicide/mood disorder
Male- F survive more suicide attempts
GLBT

Question 24

What are precipitating adolescent risk factors for suicide?

Answer 24

Substance abuse
PRIOR SUICIDE ATTEMPT
access to firearms
social stress
emotional factors

Question 25

What percent of adolescent mothers report having moderate to severe PPD?

Answer 25

56%

Question 26

What is predictive of PPD in adults?

Answer 26

Previous depression

Question 27

How does LSES relate to PPD?

Answer 27

Lower SES more likely to bear children as adolescents and are at higher risk for depression