Depression in Children and Adolescents Ad l Jean A. Frazier, MD - - PowerPoint PPT Presentation

Depression in Children and Ad l Adolescents

Jean A. Frazier, MD

Robert M and Shirley S Siff Chair Robert M. and Shirley S. Siff Chair Professor of Psychiatry and Pediatrics Vi Ch i d Di t Di i i f Child d Vice Chair and Director, Division of Child and Adolescent Psychiatry UM M di l S h l UMass Medical School

Disclosure: Jean A Frazier MD Disclosure: Jean A. Frazier, MD

Company Grants/ Research Support Consultant Speakers Bureau Other Company Support Consultant Bureau Other Bristol-Myers Squibb Company X Glaxo Smith Kline X Johnson & Johnson X Johnson & Johnson X Neuropharm X Otsuka America Otsuka America Pharmaceutical X Pfizer Inc X

Affective Illness in Youth

I t d ti

Major Depressive Disorder:

Introduction

Major Depressive Disorder: Persistent depressed mood and/or irritability f t l t 2 k d t ti t for at least 2 weeks and vegetative symptoms Dysthymia: Persistent depressed mood and/or irritability for at least one year and low self esteem, tiredness, decreased concentration.

Mood Disorders Mood Disorders

• Childhood and adolescent depression are real

M d di d i hild d d l t

• Mood disorders in children and adolescents are

among the most common psychiatric disorders

• 50% of depressed adults had their first episode

before age 20 before age 20

• Life events: stresses play a role in timing and

p y g

• nset

Depression Symptoms in Youth p y p

• Frequent sadness that won’t go away, crying

Frequent sadness that won t go away, crying

• Feeling hopeless, helpless, withdrawn
• Change in behavior, loss of interest in usual activities
• Change in sleep, appetite or energy

g p pp gy

• Missed school or poor school performance

F t h i l l i t

• Frequent physical complaints
• Irritability, fighting, trouble concentrating
• Thoughts about death, suicide or running away

E id i l

P l

Epidemiology

Prevalence:

• MDD- about 2% of children
• 5-6% of adolescents
• Dysthymia slightly lower prevalence
• Dysthymia- slightly lower prevalence

Gender distribution:

• Pre-pubertal- female/male 1:1
• Adolescent- female/male 2:1
• Adolescent- female/male 2:1

Causes of Depression in Youth Causes of Depression in Youth

Biological

• Genetics (family history)
• Genetics (family history)
• Neurochemical

Environmental/Psychological Environmental/Psychological

• Life Stress

Depression in Pre-pubertal Children Depression in Pre-pubertal Children

• Neuro-vegetative signs are also present,

although may vary. Appetite less reliable than sleep and energy

• Separation anxiety, somatic complaints and

p y, p behavior problems (especially aggression) are also common

• School failure can be the first manifestation

Depression in Adolescents Depression in Adolescents

• Clinical picture may look similar to adult MDD
• Suicidal ideation and behavior is a serious risk

and must be addressed even in less severe presentations p

• Substance abuse, conduct disorder and school

failure may also be complications failure may also be complications

Comorbidity: MDD Comorbidity: MDD

Hi h l l f bidit f d i b th li i l High levels of comorbidity are found in both clinical and non-clinical samples (Angold and Costello, 1993)

• Dysthymia 30-80%

y y

• Anxiety disorders 40-90%

ADHD/Di ti Di d 10 80%

• ADHD/Disruptive Disorders 10-80%
• Substance Use/Abuse 20-30%

Comorbidity may influence…

• severity
• duration
• relapse risk
• increased risk of treatment resistance

Bipolar Risk Factors in Juvenile MDD p

• Family history of Bipolar Disorder

Family history of Bipolar Disorder

• Early onset illness
• Psychotic symptoms or psychomotor retardation

(Strober et al.)

• Pharmacological induced hypomania

(Geller et al ) (Geller et al.)

• Poor response to antidepressants or mania

Suicide in Youth

• 2nd leading cause of death among college students
• 3rd leading cause of death among 15 – 24 year- olds
• 6th leading cause of death among 5 – 14 year- olds

g g y

• Nationally, 16% of adolescents consider suicide each

year

– By the end of high school, over 9% have actually made at least one attempt

• Over 5,000 children and adolescent die as a result of

suicide each year. Primary methods include:

– Firearms (67%) – Hanging (18%) – Overdose (5%)

Suicide Risk Factors

• MDD
• previous suicidal behavior
• positive family history of mood disorder or suicide

positive family history of mood disorder or suicide

• disruptive behavior disorder

b t b di d

• substance abuse disorder
• psychosocial stressors (loss of parents, family discord)
• exposure to family violence
• availability to fire arms

availability to fire arms

• recent rejections and humiliations

Suicide Warning Signs Suicide Warning Signs

L k f f t l i

• Lack of future planning
• Putting affairs in order
• Making comments like, “I won’t be a problem for

you much longer,” or “You won’t have to worry y g y about me”

• Suddenly becoming cheerful after a period of

Suddenly becoming cheerful after a period of depression

Childhood Depression Can Be Treated Childhood Depression Can Be Treated

• At least 70% - 80% of kids with depression

At least 70% 80% of kids with depression can be effectively treated

– Without treatment, 40% will have 2nd episode within 2 p years – 20% - 40% may go on to develop bipolar disorder

• Treatment methods may include

– Individual psychotherapy – Family therapy – Medication, e.g. TCA’s, SSRI’s

• Combined treatment with pharmacotherapy and

psychotherapy is recommended

Observations Observations

• Suicidal thinking and behavior are common
• Suicidal thinking and behavior are common

symptoms in depression C t d t t th t t t t ith

• Current data suggests that treatment with an

SSRI may increase the likelihood that a patient tells someone about their suicidal patient tells someone about their suicidal thoughts or behaviors N id t thi i t th t di ti

• No evidence at this point that medication

actually increases either the incidence of suicidal thoughts or behaviors or the risk of suicidal thoughts or behaviors, or the risk of suicide

ParentsMedGuide Th U f M di ti i T ti Childh d d Ad l t D i The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families Prepared by the American Psychiatric Association and American Psychiatric Association and American Academy of Child and Adolescent Psychiatry

In consultation with A National Coalition of Concerned Parents, Providers, and Professional Associations

As the parent or guardian of a child or teen-ager with clinical depression, or as a patient yourself, you may be aware of the recent decision by the Food and Drug Administration (FDA) to attach a cautionary label, or "black box warning," to all antidepressant medications used to treat depression and other disorders in children and adolescents. The American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry have prepared this Fact Sheet to help patients and families make informed decisions about obtaining the most appropriate care for a child with depression. p Depression is an illness that can affect every part of a young person’s life and that of his or her family. It can disrupt relationships among family members and friends, hurt school performance, and lead to general health problems through its effects on eating, sleeping, and exercise. If left untreated, or is not correctly treated, depression can be very dangerous because of the risk of suicide associated with the illness. Fortunately when depression is recognized and correctly diagnosed it can be treated successfully A comprehensive program Fortunately, when depression is recognized and correctly diagnosed, it can be treated successfully. A comprehensive program

• f care should be tailored to the needs of each child and his or her family. Treatment may include psychotherapy or a

combination of psychotherapy and medication. It may also include family therapy or work with the child’s school as well as interacting with peer support and self-help groups.

In Summary In Summary

• We can help most children and adolescents who

suffer from psychiatric disorders, including depression

–Kids need a comprehensive evaluation and an accurate diagnosis –Medication can be an important component of treatment, but medication alone is rarely the answer y –Any child on medication needs to be monitored closely –Physicians and parents need access to as much information as possible about the safety and efficacy of all treatment interventions possible about the safety and efficacy of all treatment interventions –Parents need to be advocates for their children –We need more research

• Real tragedy is that so many young people still don’t

receive the comprehensive and effective treatment th t th d d d that they need and deserve

Outpatient Services at UMASS Outpatient Services at UMASS

• Community Healthlink, Inc.
• Massachusetts Child Psychiatry
• Massachusetts Child Psychiatry

Access Project

• Child and Adolescent

Neurodevelopment Initiative Neurodevelopment Initiative

• Transition Age Youth

Transition Age Youth

Wh Who we are:

＊ We are a team of individuals committed to improving

the lives of children and families affected by mental illness and other neuro-developmental disorders.

＊ Through our research program at UMass Medical

School in the Division of Child and Adolescent P hi t k t d th d t di Psychiatry, we work to advance the understanding, diagnosis and treatment of these disorders.

What we are trying to accomplish: What we are trying to accomplish:

＊ Partnering with the community to improve services

and treatments available to children and adolescents and treatments available to children and adolescents with mental illness.

Phone: 508-856-5896 Fax: 508-856-8211 Email: ChildResearch@umassmed edu Email: ChildResearch@umassmed.edu Website: http://labs.umassmed.edu/candi

R h C di t Research Coordinators: Lauren Yakutis & Martha Castro Program Director: Ann Foley Genetic Counselor: Carol Hoffman Genetic Counselor: Carol Hoffman