Pediatric Depression Flashcards
Clues to help determine whether teens are depressed or just moody
PERVASIVENESS of the symptoms
SOCIALLY IMPAIRING – how do they do in school, able to make friends? relationship with family?
SOCIAL CONTEXT - actually depressed or did they just suffer a breakup?
BIOLOGICAL CONTEXT - family history of depression? sick? medications?
Not treating depression in adolescents leads to…
cigarette/alcohol/drug abuse
early pregnancies
more likely to drop out of school, not attend college, and thus be less likely to be employed
more likely to attempt and complete suicide
increases risk for CHRONIC DEPRESSION THROUGHOUT ADULTHOOD (and remember MDD is the most costly of all psych disorders)
Suicide
3 leading cause of death among 15-19 year olds
Females 2x as likely to attempt
Males 4x as likely to complete
Most prominent risk factor for completed suicides? Untreated depression – most cases of pediatric depression are UNRECOGNIZED and UNTREATED
What does depression look like in teens compared to adults?
Criteria for kids/adolescents is the SAME in teens as it is adults
In kids/teens we see MORE IRRITABILITY and MORE FEELINGS OF BOREDOM
Diagnosis of dysthymia in kids/adolescents requires just one year of pervasive depression symptoms as opposed to 2 years in adults
Grumpiness, anhedonia, low energy, poor appetite, poor sleep, hopelessness (all similar to adult depression)
BOREDOM, RESTLESSNESS, INCREASED SLEEP, ANXIETY about school/social life = MORE UNIQUE TO ADOLESCENTS
Most common co-mordbidity in childhood depression?
ANXIETY
Also - abuse/neglect/maltreatment/caregiver instability also highly associated
Symptoms of CHILDHOOD depression that are less common as we get older
SOMATIC COMPLAINTS seen much more in kids (abdominal pain)
AUDITORY HALLUCINATIONS – not psychosis!!!
Suicide attempts VERY RARE in kids
CHILDHOOD depression LESS CONTINUOUS WITH ADULT DEPRESSION, UNLESS THERE IS A STRONG FAMILY HISTORY OF MOOD DISORDERS
Childhood depression MORE RELATED TO STRESS, and sometimes when the stress is relieved so is the depression
Epidemiology of Childhood/Teenage Depression
MDD has a 1 year prevalence of 1% in preschoolers
2% in school aged kids
4-8% in teens
2:1 F:M by adolescence (no difference in kids)
Lifetime prevalence of MDD in teens is 11% males, 22% in females
Clinical Course of Pediatric Depression?
Median duration is 7-9 months
Lasts longer if it’s more severe, and other stressors are involved –> comorbidities, negative life events, parents with psych disorders, poor social function
Without treatment –> 90% relapse within a year of the first onset
EVEN WITH TREATMENT, 50% relapse eventually
Therapy IS useful - reduces duration of acute episodes; won’t protect from relapse once the patient is off the drug -> that is what PSYCHOTHERAPY is for!
Familial Depression
2x greater risk of MDD if a FIRST DEGREE RELATIVE has it
Kids born to MDD parents have 3x greater risk
“Depressed families” –> Grandparent AND parent with MDD –> risk for child is 60% anxiety/depression by 12 years old
The EARLIER the onset, the more likely the patient has a family member with depression
BPD in kids
Usually occurs in the LATE TEENS or EARLY 20s
Rare, highly familial
Prepubertal BPD ONLY occurs in kids with bipolar parents
Kids who experience BPD have a MUCH WORSE PROGNOSIS than those who experience it later on
Careful with meds –> SSRI for BPD can cause MANIC EPISODES –> monitor closely!!
Risk factors –> early onset MDD, psychotic features, family history, some medications
20% of kids develop BPD within 5 years of first depression episode
Treatment (Meds)
SSRI tend to work for about 70% of youths
ONLY FLUOXETINE IS APPROVED FOR KIDS aged 7-13
ESCITALOPRAM for 13-17
Black box warning for anyone under 24 –> possible increased suicide risk (ideations, actual attempts not so much)
This black box warning has lead to LESS PRESCRIPTION DRUGS being used, which actually leads to more suicides because of untreated depression!!
Start with FLUOXETINE, unless there is a strong family history of another drug being very effective!!! Then use that one
