Researchers at DHMC recently published in Pediatric Clinics of North America. Image acquired from http://www.pediatric.theclinics.com/
Researchers at the Dartmouth Hitchcock Medical Center and Children’s Health Council discussed the psychopharmacology of depression in children and adolescents in a recently published article in Pediatric Clinics of North America.
Though not as widespread, depression can occur in younger children and is commonly seen in adolescents. A range of biological, psychological, and social factors, particularly severe neglect or abuse, can lead to marked depression in this age group. The article is intended to inform primary care providers on how to effectively diagnose and treat depression in the youth, since they are the ones in regular contact with children and teens.
As the researchers note, the first step towards developing a treatment plan is to recognize depression and make an accurate diagnosis. Depression in younger children often occurs simultaneously with substance abuse, family conflicts, and personality disorder. It is important to identify concurrent diagnoses because they can alter the course of the depression and the long-term prognosis of the patient. The researchers provide an acronym, SIGE-CAPS, as criteria for identifying major depression: Sleep changes, Interest loss, Guilt, lack of Energy, Cognition/concentration loss, Appetite loss, Psychomotor (anxiety), or preoccupation with Suicide.
The next step after diagnosing depression in a child or adolescent is to educate the patient and family about the disorder and treatment options in order to plan an effective intervention. Treatment options for the youth usually fall into two broad categories: pharmacologic and nonpharmacologic. The clinician’s decision about treatment is influenced by several variables, such as the severity and duration of the symptoms and family history of medication.
Several studies have been conducted recently to show the effects of anti-depressants. Certain types of selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) have been found to be most effective. However, clinicians still need to be prepared for unexpected side effects, such as bipolar illness and the serotonin syndrome, which can vary widely across patients. In their article, the researchers provide a general guideline for the recommended dosing strategies for different antidepressant medications.
Another concern for clinicians is to evaluate the risk of a child or adolescent for committing suicide. Suicide remains the third leading cause of death in older adolescents, and fifth leading cause of death in younger children. The researchers point out that it is, thus, necessary for primary care providers to have knowledge on how to evaluate and intervene with young suicidal patients. They provide a scaled criteria, the ‘Sad Persons’ acronym, to assess whether a child is at risk of attempting suicide.
Depression is now accepted as a common and significant disorder of childhood and adolescence. Primary care physicians need to understand the essential features of these disorders to accurately diagnose and effectively treat depression. It is important to recruit families as allies, understand the effects of different treatment interventions, and be prepared for recurrences.