Allen- Adolescent Depression Flashcards
Describe the global burden of depression.
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.
Describe the burden of depression and suicide in the US.
Rate of anti-depressant use rose by 400% between 1988 and 2008
How many americans age 12 and over take anti-depressants? M/F more likely to take antidepressant?
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
Who is most likely to use anti-depressants?
Whites more than other minorities
Females more than males
14% of americans taking AD have done so 10 yrs or longer
What percentage of psychiatric medications are prescribed by primary care?
80%
What is the second leading cause of death in individuals under 18?
Suicide
What is the most at risk group for suicide in the US?
white males over age 54
What is the most at risk American Indian group?
Youth 15-25 comprise 40% of all NA suicides
What are the 4 major mood disorders?
Major Depressive disorder
Persistent Depressive Disorder
Bipolar 1 and 2
Disruptive Mood Dysregulation Disorder
What are the key characteristics of Major Depressive Disorder?
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
What are the key characteristics of Persistent Depressive Disorder?
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
What is bipolar disorder?
major depressive episode plus severe changes in mood to either extremely irritable or overly silly and elated
What is the difference between Bipolar 1 and 2?
1- mania 7 days
2- hypomania 4 days
What is Disruptive Mood Dysregulation Disorder?
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
What are some signs of adolescent depression?
Being bored
Alcohol/substance abuse
What is the prevalence of adolescent depression?
5%
By age 14 girls are 2x more likely to experience major depression
Adolescent depression often co-occurs w/ what disorders?
ADHD Conduct disorder Delinquency Drug/alcohol Anxiety Eating Disorder
What are risk factors for adolescent depression
limited social support early parental loss female family history abuse unstable parenting
What age group has the highest risk of depression?
9th graders
SSRIs should be reserved for what types of depression? How long should tx be maintained?
Moderate- severe
Fluoxetine, citalopram and sertraline
*TCAs are contraindicated
1 year
What are the 3 goals of CBT?
Challenge maladaptive beliefs
Enhance problem-solving abilities
Increase social competence
What are the key points to optimize treatment for adolescents w/ depression?
- Combined treatment of CBT and SSRI
- 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
What are predisposing adolescent risk factors for suicide?
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
What are precipitating adolescent risk factors for suicide?
Substance abuse PRIOR SUICIDE ATTEMPT access to firearms social stress emotional factors
