Depression Flashcards
Presentation of depression?
Typical symptoms of depression include:
Low mood Anhedonia, a lack of pleasure in activities Low energy Anxiety and worry Clinginess Irritability Avoiding social situations (e.g. school) Hopelessness about the future Poor sleep, particularly early morning waking Poor appetite or over eating Poor concentration Physical symptoms such as abdominal pain
Key points in depression history in children/adolescents?
There are key points that need to be considered in assessing children and adolescents with depression. Particular attention needs to be given to the psychosocial contributors. It is important to ask question in private as well as taking a history with parents or others present.
Potential triggers (e.g. loss of a family member) Home environment Family relationships Relationship with friends Sexual relationships School situations and pressures Bullying Drugs and alcohol History of self harm Thoughts of self harm or suicide Family history Parental depression Parental drug and alcohol use History of abuse or neglect
Management of depression in children/adolescents?
Mild depression or low mood associated with a single negative event (e.g. loss of a family member) can be managed with watchful waiting and advice about healthy habits, such as healthy diet, exercise and avoiding alcohol and cannabis. Follow up within 2 weeks is advised.
NICE recommend referral to CAMHS for children with moderate to severe depression. CAMHS can then initiate:
Full assessment to establish a diagnosis
Psychological therapy as the first line treatment with cognitive behavioural therapy, non-directive supportive therapy, interpersonal therapy and family therapy
Fluoxetine is the first line antidepressant in children, starting at 10mg and increasing to a maximum of 20mg
Sertraline and citalopram are second line antidepressants
When the child responds to medical treatment, it should continue 6 months after remission is achieved
When they do not respond to medical treatment they may require intensive psychological therapy
Where there is follow up monitoring in secondary care, the mood and feelings questionnaire (MFQ) may be used to assess progress.
Admission may be required where there is high risk of self harm, suicide or self-neglect or where they may be an immediate safeguarding issue.
