Mental Health Book

http://www.fpnotebook.com/

Childhood DepressionAka: Depression in Children, Pediatric Depression, Adolescent Depression, Major Depression in Children

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  1. Epidemiology
    1. Incidence: 5% in ages 9-17 years old
    2. Gender predominance: Girls by 2 fold
  2. Precautions
    1. Missed or incorrect diagnosis occurs in up to 70%
    2. Pitfalls in diagnosis
      1. Atypical presentations: Headaches, stomache pain
      2. Downplayed symptoms if parents are also depressed
  3. Risk factors
    1. Comorbid illness
    2. Puberty-related hormonal changes
    3. Family History of depression
    4. Medications: Accutane
    5. Emotional stressors (e.g. relationship break-ups)
    6. Child Abuse
    7. Tobacco abuse
    8. Attention Deficit Disorder
  4. Screening
    1. Depression Screening Tools
    2. Childrens Depression Inventory (CDI)
    3. Reynolds Child Depression Scale
  5. Diagnosis
    1. See Major Depression Diagnosis
  6. Management
    1. Cognitive behavior therapy
    2. Psychotherapy
    3. Selective Serotonin Reuptake Inhibitors
      1. FDA black box warning
      2. Fluoxetine (Prozac) appears to be effective
      3. Unclear if other SSRIs are effective
      4. FDA recommends avoiding Paroxetine
    4. Other Antidepressants not recommended
      1. Tricyclic Antidepressants appear ineffective
      2. No evidence supporting MAO inhibitors, Effexor
  7. Complications
    1. Suicide
      1. Seriously considered in 20% of teens
      2. Attempted Suicide in 8% of teens
    2. Growth delay or developmental delay
    3. Impaired learning
    4. Persistent depression into adulthood (2-4 fold risk)

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