Depression: Difference between revisions
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==Background== | ==Background== | ||
Suicide is the leading cause of death among adolescents in the U.S.<ref>Miller, Leslie, and John V. Campo. “Depression in Adolescents.” New England Journal of Medicine, edited by Allan H. Ropper, vol. 385, no. 5, 2021, pp. 445–49. Crossref, doi:10.1056/nejmra2033475.</ref> | |||
Depression in adolescence predicts depression & anxiety in adulthood and most affected adults had their first depressive episode during adolescence, highlighting the need for early identification and treatment. <ref>Miller, Leslie, and John V. Campo. “Depression in Adolescents.” New England Journal of Medicine, edited by Allan H. Ropper, vol. 385, no. 5, 2021, pp. 445–49. Crossref, doi:10.1056/nejmra2033475.</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 01:45, 9 August 2021
Background
Suicide is the leading cause of death among adolescents in the U.S.[1] Depression in adolescence predicts depression & anxiety in adulthood and most affected adults had their first depressive episode during adolescence, highlighting the need for early identification and treatment. [2]
Clinical Features
Major Depressive Disorder (MDD) - Must have 5 of the following features for >2 wks[3]
- Depressed mood or anhedonia (must be present)
- SIGECAPS
- Sleep decreased (Insomnia with 2-4 am awakening)
- Interest decreased in activities
- Guilt or worthlessness (Not a major criteria)
- Energy decreased
- Concentration difficulties
- Appetite disturbance or weight loss
- Psychomotor retardation/agitation
- Suicidal thoughts
Differential Diagnosis
General Psychiatric
- Organic causes
- Psychiatric causes
Evaluation
- Evaluate suicide risk
- Depression screening with PHQ-9, the PHQ-2, the Beck Depression Inventory for Primary Care, and the WHO-5
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
- Psych consult or admission if high risk of suicide
- Consider consult with psychiatric team in other cases, particularly if severe symptoms and patient not already plugged into psych care
- Pharmacologic agents (typically not started in ED due to need for monitoring and adjustment)
- SSRIs (citalopram, fluoxetine, paroxetine, sertraline)
- SNRIs (duloxetine, venlafaxine, milnacipran)
- Serotonin modulators (trazodone)
- Atypical (bupropion, mirtazapine)
- TCAs (amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, trimipramine)
- MAOIs (isocarboxazid, phenelzine, selegiline)
Disposition
See Also
External Links
References
- ↑ Miller, Leslie, and John V. Campo. “Depression in Adolescents.” New England Journal of Medicine, edited by Allan H. Ropper, vol. 385, no. 5, 2021, pp. 445–49. Crossref, doi:10.1056/nejmra2033475.
- ↑ Miller, Leslie, and John V. Campo. “Depression in Adolescents.” New England Journal of Medicine, edited by Allan H. Ropper, vol. 385, no. 5, 2021, pp. 445–49. Crossref, doi:10.1056/nejmra2033475.
- ↑ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.