Depression - Paediatrics

Depression

·        Mood disorders are prevalent and serious disorders in children and adolescents. Leads to difficulties at school and in social relationships

·        1 year prevalence estimated as high as 10%

·        Same diagnostic criteria as for adult – but diagnosis harder. More likely to present with separation anxiety, phobias, somatic complaints and behaviour issues. More likely to talk of profound boredom and feeling unloved and lonely than appetite and sleep change

·        Most do recover, but recurrence is more common than in adults

·        Clinical approach:

o   See the teen on their own 

o   Observe: ¯energy, anxiety, anger, shame, variability in affect

o   Listen: the teen is more likely to talk if they feel they are being heard 

o   Consider differentials: Depression, drug abuse, eating disorder, psychosis (actual or prodrome), medical 

o  Suicide assessment

·        Aetiological factors to consider:

o  Family context

o  Cultural context: are they comfortable about who they are in a cultural sense

o  Peer group: Have they friends, how do they support him/her?

o  School: bullying, what‟s hard at school, current stressors

o  Life events: losses, abuse

o  Psychological: negative ways of thinking, learned helplessness

·        Treatment involves the child, parents and school. Aim is to shorten the episode. Treatment can include:

o  Education

o  Counselling: for milder depression, no remediable family factors, recent life events, if they want it

o  Family therapy

o  A range of individual therapy types – usually through referral 

o  Medication: less evidence of effectiveness in adolescents. Consider discussion with a psychiatrist. Usually SSRIs

·        Referral when:

o  Significant suicide risk

o  Possible psychosis

o  Abuse

o  Severe family discord

o  Failure to improve