Section VI. Special Populations - CAP

Question 1

In 2012, what % of Canadian youth reported at least 1 MDE?

Answer 1

8.2%

Question 2

List typical presenting symptoms for children (vs. teens) with MDD

Answer 2

• appetite change
• weight change
• psychotic symptoms

Question 3

In treatment of depression with youth, what does ‘supportive clinical care’ consist of?

Answer 3

• supportive listening
• lifestyle advice
• discussion of good sleep hygiene
• proper eating habits
• good exercise habits

Question 4

What are the first line recommendations for treatment of youth with depressive disorders? If no response?

Answer 4

CBT or IPT (level 1 evidence)
Internet-based psychotherapy for mild (level 1)

If no response, add SSRI to psychotherapy

Question 5

What are the 2nd line recommendations for youth with depression? If no response?

Answer 5

Fluoxetine (level 1)
Escitalopram, sertraline, citalopram (level 2 evidence)

If no response, switch to another SSRI (if unresponsive to Fluoxetine)

Question 6

What are the 3rd line recommendations for youth with depression? If no response/ treatment resistent?

Answer 6

Venlafaxine or TCAs (level 2 evidence)

If no response - Neurostimulation (ECT or rTMS)

Question 7

Which SSRI specifically should be avoided in kids with QT syndrome?

Answer 7

Citalopram

Question 8

When an antidepressant is started in a child, what is the frequency of follow up?

Answer 8

• weekly for the first 4 weeks
• then F/U q.2 weeks for 1 month
• then F/U q. 3 months

Question 9

How long should a child trial an adequate dose of antidepressant before trying something new?

Answer 9

12 weeks

Question 10

How long should youth be treated with pharmacotherapy for depression?

Answer 10

1 year or more for maintenance treatment advised for 1 year or more (for those with a history of at least 2 MDEs or 1 severe/ chronic MDE)

6 to 12 months for those with no MDD history

Question 11

When is the best time to taper antidepressant?

Answer 11

in a stress-free time (e.g., summer)

Question 12

What are some factors to consider if youth seems non-responsive to 1st line treatment?

Answer 12

• query misdiagnosis (e.g., undetected bipolar, comorbid medical or psychiatric d/o)
  -treatment non-adherence
• psychosocial factors (e.g., bullying, sexual identity, family conflict)

Question 13

In the TORDIA study, what were the main concerns in using Venlafaxine (SNRI)?

Answer 13

Venlafaxine associated with higher rate of self-harm events in those with SI

** therefore, SSRI preferred

Question 14

True/ False - ECT for patients younger than 12 yo is recommended

Answer 14

False