depression Flashcards
Half of all lifetime mental disorders begin by age ____.
14
twice as common in girls
Difficult to distinguish between _________ and _________ adolescent growth and development.
depression and “normal”
What is the leading cause of suicidal behavior and suicide?
Depression
psychosocial dysfunction manifested by: Severe sadness Withdrawn behavior Boredom Low self-esteem Feeling helpless and hopeless Sense that there is no meaning in life
Definition of major depression
Criteria for major depressive disorder by DSM-V includes
_____or more of the following symptoms must be present during same ________ period; at least one of the symptoms is depressed mood or loss of interest or pleasure:
Depressed or irritable mood
Diminished interest or pleasure in activities
Weight change or appetite disturbance
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or guilt
Disturbed concentration or indecisiveness
Recurrent thoughts of death, suicidal ideation, or suicide attempt
five or more symptoms
during same 2 week period of time
What is the DSM-5 Criteria for Persistent Depressive Disorder (Dysthymia)?
An overwhelming, chronic state of depression
A depressed mood most days for at least two years; baseline irritable or depressed
Must not have gone for more than two months without two or more of the following symptoms:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy
Low self-esteem
Difficulty making decisions
Feelings of hopelessness
Is family history a significant risk factor?
YES
What are clinical manifestations of depression in infants and young children?
Unable to verbalize feelings
Can present with:
Pattern of depressed affect, lack of pleasure; should be noted across settings, activities, and relationships
Failure to thrive
Developmental delays such as speech and motor
Repetitive self-soothing behaviors such as rocking
Poor attachment behaviors
Loss of developmental skills
What are clinical manifestations of depression in Toddlers and Preschoolers?
Unable to verbalize feelings Can present with: Lack of energy Eagerness to please, tendency to cling Separation problems that are persistent and intense Sadness, irritability, lack of pleasure Poor appetite and weight loss Sleep issues Loss of developmental milestones or regression of behavior Increased physical complaints
What are clinical manifestations of depression in school aged children?
Able to verbalize feelings, but not always willing to Can present with: Irritability, anger, hostility Hyperactivity, reckless behavior Difficulty handling feelings Frequent absences, school phobia Feelings of anger, upset, sadness Loss of interest and pleasure in usual activities Describing themselves in negative terms Feeling guilty about behaviors
What are clinical manifestations of depression in adolescents?
Stressed about separation from family, college decisions, school pressures, behavior choices Cognitive development allows for more mature feelings of despair, blame, guilt, self-hate; capable of abstract thinking and recognizing feelings (Piaget) Can present with: Decreased interest or pleasure Withdrawal Hopelessness Changes in weight or appetite Changes in sleep patterns Substance abuse or self-medication
What is the most important part of diagnosing depression in children and adolescents?
History and Assessment
What standardized screening tools can be used in assessing children or adults for depression?
Child Behavior Checklist, 4–18 years
Children’s Depression Rating Scale, 6–12 years
Beck Depression Inventory: adolescents and adults
PHQ-9 (PHQ-2)
HEADSS: adolescents screening tool
What is the strongest predictor for suicide?
Suicide ideation or attempts: strongest predictor is a previous attempt
What are some differentials for depression?
Anemia Chronic fatigue Eating disorder Endocrine disorder Hypothyroidism Chronic infection Substance abuse: alcohol, marijuana, cocaine Medications: some antihypertensives, clonidine, phenobarbital
What is the black box warning on SSRI medications?
Increased risk for suicide and suicidal ideation in individuals under the age of 25 taking SSRIs
***However the benefits outweigh the risks.
What is the best treatment for depression?
Cognitive behavioral therapy (psychotherapy)
Medication
Which medication is considered first line in the treatment of depression?
SSRIs
If no benefit after ________, consider another medication
4 weeks
If mild response, consider continuing for ________ to optimize response
10 weeks
what is the duration of treatment for children/adolescents?
up to a year.
How long should a child be symptom-free before decreasing dose?
for 3 months
How long are children treated for depression?
Usually 6–9 months, up to 12 months, until child demonstrates a normal mood level
Taper antidepressant slowly
**Depression should be treated for a minimum of SIX months.
Which anti-depressants should not be used for childhood/adolescent depression.
Tricyclic antidepressants
What is the only FDA-approved medication for depression in children/adolescents.
Prozac
What are some common comorbidities seen in patients with depression?
panic attacks
bulimia or anorexia
OCD
frequent mood swings
Which medical illnesses can mimic depression?
hypothyroidism dementia low blood sugar vitamin D deficiency caffeine withdrawal
T/F: Every patient should be tried off an antidepressant at 12 months
TRUE
What is a herbal medication that individuals use for treatment of depression?
St. John’s wort
Can St. John’s Wort decrease estrogen in birth control and hormone therapy?
YES
Can you combine St. John’s Wort with other anti-depressants?
NO
