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depression in children & adolescents

Etiology: (risk factors) 1) socioeconomic status 2) school environment - higher average household income (averaged for school) negatively associated with depression Clinical manifestations: - irritability, fear, & anxiety, & familial & social risk factors may help predict depression in children with a family history of depression [5] Management: 1) safety plan a) limit access to lethal medication & weapons b) enlist a 3rd party c) establishing an emergency communication plan 2) treatment of maternal depression may reduce risk of psychiatric disease in her child [3] 3) early intervention for adolescents with mental health issues reduces incidence of later depression [7] 4) mild depression - consider active support & monitoring for 6-8 weeks prior to treatment [8] 5) for moderate-to-severe depression or complicating factors like substance abuse, consult mental health specialist [8] 6) adolescents in need of therapy - cognitive behavioral therapy - interpersonal psychotherapy - SSRI 7) caution using selective serotonin reuptake inhibitors a) fluoxetine might be more effective than placebo in treating depression in children & adolescents [4] b) paroxetine & imipramine are ineffective, & even harmful, for treating major depression in adolescents [3] 8) moderate-to-vigorous physical diminishes symptoms of depression in elementary school children [6] 9) screening for depression >= 12 years of age [8]

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screening for depression (includes depression assessment tools)

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depression

References

  1. Journal Watch 23(24):189, 2003 Goodman F et al, J Pediatr 143:451, 2003 PMID: 14571218 Fortenberry JD, J Pediatr 143:427, 2003 PMID: 14571213 (no abstract)
  2. Weissman MM, Pilowsky DJ, Wickramaratne PJ, Talati A, Wisniewski SR, Fava M, Hughes CW, Garber J, Malloy E, King CA, Cerda G, Sood AB, Alpert JE, Trivedi MH, Rush AJ; STAR*D-Child Team. Remissions in maternal depression and child psychopathology: a STAR*D-child report. JAMA. 2006 Mar 22;295(12):1389-98. PMID: 16551710
  3. Le Noury J et al Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ 2015;351:h4320 PMID: 26376805 - Doshi P No correction, no retraction, no apology, no comment: paroxetine trial reanalysis raises questions about institutional responsibility. BMJ 2015;351:h4629 PMID: 26377109 http://www.bmj.com/content/351/bmj.h4629 - Henry D, Fitzpatrick T Liberating the data from clinical trials BMJ 2015;351:h4601 PMID: 26377210 http://www.bmj.com/content/351/bmj.h4601
  4. Cipriani A, Zhou X, Del Giovane C et al Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet. June 8, 2016 PMID: 27289172 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2930385-3/abstract
  5. Rice F, Sellers R, Hammerton G et al Antecedents of New-Onset Major Depressive Disorder in Children and Adolescents at High Familial Risk. JAMA Psychiatry. Published online December 7, 2016. PMID: 27926743 http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2588635 - Glowinski AL, Rosen MS. Prevention Targets for Child and Adolescent Depression. JAMA Psychiatry. Published online December 7, 2016. PMID: 27926744 http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2588633
  6. Zahl T, Steinsbekk S, Wichstrom L Physical Activity, Sedentary Behavior, and Symptoms of Major Depression in Middle Childhood. Pediatrics. January 2017 PMID: 28069664 http://pediatrics.aappublications.org/content/early/2017/01/05/peds.2016-1711
  7. Neufeld SA, Dunn VJ, Jones PB et al Reduction in adolescent depression after contact with mental health services: a longitudinal cohort study in the UK. Lancet Psychiatry. Jan 10, 2017 PMID: 28087201 Free full text http://thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30002-0/fulltext - Rice F, Eyre O, Riglin L, Potter R Adolescent depression and the treatment gap. Lancet Psychiatry. Jan 10, 2017 PMID: 28087200 Free full text http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30004-4/fulltext
  8. Zuckerbrot RA, Cheung AH, Jensen PS et al Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. From the American Academy of Pediatrics. Statement of Endorsement. Pediatrics Feb 2018, e20174081; PMID: 29483200 http://pediatrics.aappublications.org/content/early/2018/02/22/peds.2017-4081 - Cheung AH, Zuckerbrot RA, Jensen PS et al Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management. From the American Academy of Pediatrics. Statement of Endorsement. Pediatrics February 2018 PMID: 29483201 http://pediatrics.aappublications.org/content/early/2018/02/22/peds.2017-4082