Depression: Difference between revisions

 
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==Background==
==Background==
*Depression is a risk factor for suicide, which 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<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==
Must have 5 of the following features for major depressive disorder for >2 wks<ref>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.</ref>
Major Depressive Disorder (MDD) - Must have 5 of the following features for >2 wks<ref>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.</ref>
*Depressed mood or anhedonia (must be present)
*Depressed mood or anhedonia (must be present)
*SIGECAPS
*SIGECAPS
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**Appetite disturbance or weight loss
**Appetite disturbance or weight loss
**Psychomotor retardation/agitation
**Psychomotor retardation/agitation
**Suicidal thoughts
**[[suicide|Suicidal thoughts]]


==Differential Diagnosis==
==Differential Diagnosis==
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==Evaluation==
==Evaluation==
Depression screening with PHQ-9, the PHQ-2, the Beck Depression Inventory for Primary Care, and the WHO-5
*Evaluate [[suicide|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}}
{{General ED Psychiatric Workup}}


==Management==
==Management==
*Consult with psychiatric team
*Psych consult or admission if high risk of [[suicide]]
*Pharmocologic agents, typically not started in ED due to need for monitoring and adjustment
*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)
**Antidepressants can take up to 8 weeks to reach maximum effect, so discuss expectations to ensure adherence.<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>
**SSRIs (citalopram, fluoxetine, paroxetine, sertraline)
**SSRIs (citalopram, fluoxetine, paroxetine, sertraline)
**SNRIs ([[duloxetine]], [[venlafaxine]], milnacipran)
**SNRIs ([[duloxetine]], [[venlafaxine]], milnacipran)
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**TCAs ([[amitriptyline]], clomipramine, desipramine, [[doxepin]], imipramine, [[nortriptyline]], trimipramine)
**TCAs ([[amitriptyline]], clomipramine, desipramine, [[doxepin]], imipramine, [[nortriptyline]], trimipramine)
**MAOIs (isocarboxazid, phenelzine, selegiline)
**MAOIs (isocarboxazid, phenelzine, selegiline)
*Cognitive Behavioral Therapy and Interpersonal psychotherapy have been shown to be effective in treating depression in adolescents.<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>


==Disposition==
==Disposition==
*See [[Sad person's score]]
*Those at risk for self-harm or harm to others should be admitted/transferred for psych evaluation.


==See Also==
==See Also==
*[[SAD PERSONS score]]


==External Links==
==External Links==

Latest revision as of 01:57, 9 August 2021

Background

  • Depression is a risk factor for suicide, which 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[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

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

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)
  • Cognitive Behavioral Therapy and Interpersonal psychotherapy have been shown to be effective in treating depression in adolescents.[5]

Disposition

  • Those at risk for self-harm or harm to others should be admitted/transferred for psych evaluation.

See Also

External Links

Screening test for depression

References

  1. 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.
  2. 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.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  4. 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.
  5. 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.