Depression: Demographic and Sociocultural Factors in Treatment

Demographic and Sociocultural Factors in Treatment

Children

It is increasingly important to identify children at risk for MDD. There have been insufficient controlled studies of pharmaco-therapy or psychotherapy in children with MDD. However, early studies of SSRIs appear promising in terms of overall treatment efficacy in children with MDD

Adolescents

Adolescent-onset depression with psychotic features may be an early predictor of bipolar course. Adolescent-onset depression, therefore, must be carefully diagnosed, ruling out a bipolar his-tory in the family and assessing evidence for mixed hypomanic or manic states in the prepubertal or pubertal period. The appro-priate prescription of lithium carbonate in those individuals with bipolar vulnerability must precede antidepressant pharmaco-therapy. Alternatively, early studies suggest the role for standard SSRIs in adolescents with nonbipolar depression.

Older Adults

MDD in older adults is often characterized by more prominent somatic signs and cognitive impairment. It is important to diag-nose and treat depression to minimize associated morbidity and mortality. Standard SSRI pharmacotherapy is likely to be associ-ated with demonstrated efficacy as is depression-specific psycho-therapy assuming the level of depression is mild to moderate.

Gender

Because of substantial hormonal changes associated with the on-set of menses, pregnancy and delivery, and menopause, hormonal effects must be part of the standard assessment of depression. Woman may be at somewhat higher risk for depression at these critical intervals of hormonal change. Standard antidepressant pharmacotherapy as well as depression-specific psychotherapy appear to be equally effective in both men and women. Both men and women require careful attention to sexual side effects of antidepressant pharmacotherapy in the course of the longitudinal management.