Depressive Disorders in Children [other than BP or DMDD]

Question 1

DSM-5 Depression Symptoms

Answer 1

Frequent sadness that won’t go away, crying

Feeling hopeless, helpless, withdrawn

Change in behavior, loss of interest in usual activities

Change in sleep, appetite or energy

Missed school or poor school performance

Frequent physical complaints

Irritability, fighting, trouble concentrating

Thoughts about death, suicide or running away

Question 2

Typical Symptoms of Depression Not Listed in DSM-5

Answer 2

Feelings of being unloved
[and possibly manipulation]
“you don’t love me!” – coercive cycle of sadness

Anger

Self-deprecation

Somatic complaints

Anxiety

Disobedience

**DMDD=clear outbursts, rages–NOT seen in depression

Question 3

DSM-5 Criteria for Major or Persistent Depression

Answer 3

MDD

• 5+ of the following symptoms have been present during the same 2 week period and represent a change from previous functioning
• at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Change in Functioning is always a key component–e.g., child can be sad in school, but passing classes and ok at home–this does not satisfy criteria

significant distress is observed [vs. child-perceived]

Persistent depressed/irritable mood

Change in sleep

Change in appetite/weight

Fatigue

Decreased concentration

Psychomotor change

Anhedonia

Worthlessness

Thoughts of death/suicidality

Guilt

Hopelessness

Question 4

Prevalence of Depressive Disorders

Answer 4

MDD- 2% of children, 5-6% adolescents

Dysthymia (more irritable than sad)–slightly lower prevalence

Pre-puberty female/male 1:1
Adolescent female/male 2:1

Question 5

Biological Causes of Depression in Youth

Answer 5

Genetics – 3X more likely with family history of depression

Neurochemical/neurotransmitters

Personality/Temperament traits related to inability to regulate emotions or distress

Negative attributional cognitive style

*Study by Tiffany Field, depression in preschoolers: mothers of infants who exhibit expressions of depression (flat affect for 1 to 2 days) – infants showed lowered engagement as a result of imitation

Question 6

Environmental Causes of Depression in Youth

Answer 6

Learned helplessness (Seligman)

Low parental satisfaction with child

Early adverse experiences: parental separation or death

Recent adverse events

Neglect, abuse, family conflict

Few positively reinforcing experiences (Lewinsohn)

Question 7

Depression in Prepubescent children

Answer 7

Appetite is a less reliable indicator for clinicians than sleep and energy as a symptom of depression
*kids know how they feel by whether or not they have an appetite – anxious or depressed, but it’s more difficult to rely on thoughts

Separation anxiety, somatic complaints and behavior problems – especially aggression – are also common

School failure can be the first manifestation

Question 8

Depression in Adolescents

Answer 8

Clinical picture may look similar to adult MDD

**Teen depression differs from adult depression in that they are more irritable, and may exhibit cutting (numbness, need arousal)

Suicidal ideation and behavior is a serious risk and must be addressed even in a less severe presentations

Substance abuse, conduct disorder and school failure may also be complications

Question 9

MDD Comorbidity

Answer 9

High levels of comorbidity are found in both clinical and nonclinical samples, which influences severity, duration, relapse rates, and increased risk of treatment resistance

Dysthymia [Persistent Depressive Disorder] 30-80%

Anxiety disorders 40-90%

Substance Use / Abuse 20-30%

ADHD/Disruptive Disorders 10-80%

Question 10

Treatment of Childhood Depression

Answer 10

70-80% of children with depression can be effectively treated

Without treatment, 40% will have second episode within two years

20 to 40% may go on to develop bipolar disorder

Treatment methods:

• individual psychotherapy
• family therapy
• medication

Combined treatment with pharmacotherapy and psychotherapy is recommended

Question 11

Psychotherapy vs. Antidepressant Medication

Answer 11

CBT is effective for treatment of uncomplicated depression, and in the longer term prevention of relapse and major depression

Antidepressants
*May be more useful for severe depression
*More rapid onset of action and psychosocial interventions
Useful for comorbid anxiety disorder or eating disorder

Question 12

CBT, general

Answer 12

Behavioral problem solving

Identifying mood/mood monitoring

Target negative cognitive distortions

Communication skills/conflict resolution

Social skills training

Pleasant activity scheduling

Relaxation/guided imagery

Use of humor to cognitively reframe

Develop long-term goals