Depression in adolescence

Depression is a major source of suffering in adolescence and is considered an important risk factor for suicide, the second leading cause of death among adolescents in the US.

Depression in adolescence predicts depression and anxiety in adulthood. 

Most affected adults had their first depressive episode during adolescence.

The prevalence of depression has increased in all age groups, but the increase among adolescents has outpaced that among adults.

The lifetime prevalence of major depressive disorder among 13 – 18 year olds is 11%, with a 12 month prevalence of 7.5%.

Adolescent girls have a higher rate and more severe episodes of depression than males. 

Older adolescents have higher prevalence rates and more severe episodes then younger adolescents.

A typical depressive episode lasts approximately 27 weeks and can impair adolescent’s academic advancement,  developmental milestones, autonomy and independence.

Youth suicide has been increasing for greater than a decade. 

Suicidal rates among girls have increased disproportionately with a male to female suicide rate among 10-19 year olds declining, most likely because girls have increasingly chosen lethal means such as hanging and suffocation.

Depression can be familial.

Depressive disorders can extend across generations.

Children with depressed parents and depressed grandparents have the highest rates of major depressive disorder.

Parental depression is a negative influence on a young person‘s response to treatment for anxiety and depression.

Treatment of parental depression is associated with reduction in depression and improve functioning among young offspring.

Factors for risk among adolescents include: female sex, family history of depression, personal history of trauma, chronic medical illness, family conflict, and minority sexual orientation.

Anxiety often precedes and is a commonly present  with depression in adolescents.

The assessment of a depressed adolescent includes signs and symptoms of psychopathology, particularly anxiety, mania, psychosis, bipolar disorder, and substance abuse.

Cannabis use in adolescence is associated with depression and suicidal behavior.

Rarely unrecognized physical illness such as hypothyroidism or anemia can account for depression.

Regular daily schedule, good nutrition, moderate activity and exercise, pharmacologic intervention and psychotherapy are the major mechanisms of treatment for depression in adolescents.

Selective serotonin reuptake inhibitors (SSRIs) fluoxetine and escotalopram are major drugs for the treatment of depression in adolescence, but other SSRIs and serotonin-norepinephrine reuptake inhibitors, such as venlafaxinr are also commonly used.

Anti-depressive agents can take 6-8 weeks to reach maximum benefit. 

Treatment with antidepressant medication should be continued for a minimum of six months, and most recommend at least a year to decrease the likelihood of recurrence.

Side effects of anti-depressant medication‘s include: headache, gastrointestinal disturbances, sedation, insomnia, and dry mouth.

Management efforts include the encouragement of mood hygiene with regular daily scheduling, good nutrition, moderate activity and exercise, pharmacological intervention and psychotherapy.

Selective serotonin reuptake inhibitors (SSRIs) fluoxetine and escitalopram are approved for the treatment of depression in adolescents, but other SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine are commonly used off label.

Once depression symptoms have remitted, practice guidelines suggest maintenance treatment for a minimum of six months to one year.

Common side effects of anti-depressant medication during adolescence include: headache, G.I. discomfort, sedation or insomnia, and dry mouth.

More common in adolescence is a side effect activation manifested by insomnia, disinhibition, and restlessness that may lead to discontinuation of the medication.

Starting with a low-dose and increasing slowly can prevent such activation symptoms.

There is a small but significant risk difference for suicide ideation or attempted suicide between adolescents receiving an antidepressant drugs and those receiving placebo.

The number of patients treated for depression in adolescence revealed that one person in 10 will respond.

cognitive behavioral therapy and interpersonal psychotherapy are effective in treating depression in adolescence.


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