✎✎✎ Depression In Adolescents Case Study

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Depression In Adolescents Case Study



DSM-5 development. Depression severity. Archived Depression In Adolescents Case Study the original on 11 October As a result, many studies included in the review were not included Essay On Tabagism the updated review. Further countering Depression In Adolescents Case Study monoamine hypothesis is the fact that rats with lesions of the dorsal Depression In Adolescents Case Study are not more depressive than controls, the finding of increased jugular 5-HIAA in people who are depressed Depression In Adolescents Case Study normalized with Depression In Adolescents Case Study treatment, and the preference Cardinal Direction Rhetorical Analysis Depression In Adolescents Case Study in people who are depressed. Von Korff, M. Cambridge: Cambridge University Press. Summer Senior Program Case Study more about research conducted at NIMH.

Psychoanalytic Psychotherapy as a Treatment for Depression in Adolescents A Case Study GJSSS 2018 42

Garnefski and colleagues [ 15 ] found no difference in type of stressful life event and the association with depressive symptoms in adolescents aged 14 to For clinically depressed adolescents, however, it is unclear as yet whether this is also true. The dual process model of cognitive vulnerability to depression hypothesizes that associative thought processing automatic processing induces depressive symptoms when no correction occurs by explicitly reflective processing [ 30 ]. This is especially the case when the associative processing is negatively biased with thoughts about oneself.

Furthermore, life stress appears to deplete cognitive resources, which are necessary for reflective processes to correct associative processing [ 30 ]. This dual process of self-referent association and cognitive reflection is considered to be of importance for the regulation of emotions. Difficulty in regulating evoked emotions is often thought to lead to depression [ 11 , 12 , 31 ]. In adults, emotion regulation plays a central role in the etiology and maintenance of clinical levels of psychopathology [ 32 — 34 ]. Emotion regulation is a complex process with un- conscious, cognitive, and self-regulatory components. Emotion regulation strategies can be adaptive or maladaptive. Maladaptive emotion regulation has repeatedly been linked to various mental disorders, including the onset of depressive symptoms [ 35 — 39 ].

Maladaptive emotion regulation is also a risk factor for the recurrence of depression in adults [ 40 ]. Furthermore, findings suggest that the strength of the relationship between maladaptive emotion regulation strategies and psychopathology may be a function of clinical severity [ 41 ]. Some specific maladaptive cognitive emotion regulation strategies such as self-blame, rumination and catastrophizing, are associated with higher levels of depressive symptoms in adolescence, while adaptive strategies such as positive reappraisal, positive refocusing and putting things into a broader perspective, are associated with less depressive symptoms [ 15 , 42 ].

Only a few studies have established the relationship between stressful life events and emotion dys regulation in adults [ 10 ] and adolescents [ 13 ]. The type of life event influences the use of specific cognitive emotion regulation strategies, with health threat being associated with self-blame and relational challenge with other-blame in adolescence [ 15 ]. As pointed out, stressful life events have an impact on emotion regulation, which in turn influences the degree of depressive symptoms. Therefore, emotion regulation can be considered a mediator in the relationship between stressful life events and depressive symptoms [ 43 , 44 ].

Studies on emotion regulation as a mediator of depressive symptoms in adolescents are scarce. One study reported that emotion regulation strategies were found to mediate the relationship between interpersonal stress and depressive symptoms in undergraduate students [ 13 ]. It is unclear if this mediation is also present when adolescents have high levels of depressive symptoms, or whether the use of specific emotion regulation strategies mediates the relation between certain stressful life events and depressive symptoms.

The aim of this study is to examine if the relation between stressful life events and depressive symptoms is mediated by cognitive emotion regulation strategies and whether these potentially mediating effects differ per type of stressful life event Fig 1. We used a multi-sample approach, including a community sample and clinically referred depressed outpatients. Mediation was studied for the whole sample, as well as for the depressed and non-depressed adolescents separately. We expected to find that [ 1 ] the relationship between stressful life events loss, health threat or relational challenge and depressive symptoms is mediated by cognitive emotion regulation strategies; [ 2 ] the model for mediation would be specific for type of stressful life event: self-blame would be important after health threat and other-blame after relational stress, and no mediation would be present after loss; [ 3 ] the model would also be specific in that the pathway from stressful life events via cognitive emotion regulation to depressive symptoms would be more pronounced in adolescents with high levels of depressive symptoms compared to adolescents with low levels of depressive symptoms.

The result was a final sample of adolescents aged 11 to 22 years These groups will be referred to as non-depressed and depressed. The non-depressed group consisted of adolescents Two samples were used in this study. The first sample consisted of adolescents age range 11—21 from the general population who were recruited by Master's degree students in schools and sports associations across The Netherlands.

The adolescents were asked to participate in the research. After written informed consent forms were obtained from the participants and their parents, a self-report questionnaire was completed. The second sample participated in an effectiveness trial comparing Cognitive Behavioral Therapy to usual care for more information, see [ 45 ]. A psychologist informed adolescents and parents about the study and when both gave written informed consent, self-report questionnaires were completed pre-treatment using online or paper-and-pencil questionnaires.

The degree of depressive symptoms was measured with the Child Depression Inventory-2 [ 46 , 47 ], a revision of the CDI [ 48 , 49 ]. The CDI-2 is a self-report questionnaire for children 7 to 17 years that reflects affective, behavioral, and cognitive symptoms of depression. Each of the 28 items offers 3 assertions: non-depressed score 0, e. The participants had to choose the assertion that applied most during the past two weeks. Total scores could range from 0 to 56, and a score of 12 or above based on the CDI is considered a clinically relevant score [ 49 ]. In this sample, Cognitive emotion regulation strategies were investigated with the Cognitive Emotion Regulation Questionnaire [ 50 ]. The CERQ consists of 36 items, reflecting 9 conceptually distinct adaptive or maladaptive strategies.

Items refer to what someone thinks in response to a life event. The four maladaptive subscales are: Self-blame thoughts of putting the blame of what you have experienced on yourself , Other-blame thoughts of putting the blame of what you have experienced on others , Catastrophizing thoughts of explicitly emphasizing the terror of an experience and Rumination thinking about the feelings and thoughts associated with the negative event. The five adaptive subscales are: Putting into perspective thoughts of playing down the seriousness of the event or emphasizing the relativity when comparing it to other events ; Positive refocusing thinking about joyful and pleasant issues instead of thinking about the actual event ; Positive reappraisal thoughts of attaching a positive meaning to the event in terms of personal growth ; Acceptance thoughts of accepting what you have experienced and resigning to yourself what has happened ; and Refocus on planning thinking about what steps to take and how to handle the negative event.

Each subscale contains 4 items measured on a 5-point Likert scale ranging from 1 almost never to 5 almost always , with a higher score indicating more use of the specific adaptive strategy. Because extreme scores on Acceptance could be maladaptive the score was transformed into a categorical variable high score above 14 , low score less than 10 and medium [ 36 ]. Research on the CERQ subscales indicated that internal consistencies were good, ranging from. In the present study, alphas ranged from good. For this study, we constructed the Life Event Scale [ 52 ], a 23 item self-report questionnaire about three types of life events, based on the distinction of psychological stress made by Lazarus [ 16 ]; Loss 1 item: death of a loved one including pets , Health threat 8 items: serious mental illness, suicide attempt, sexual abuse, psychological abuse, alcohol or drug abuse, crime and accidents concerning the self not for suicide attempt , parent, sibling or friends , and Relational or situational challenges 14 items: parental divorce, step-parents, moving, changing schools, romantic break-up, police contact parent or self , redundancy parent or self , pregnancy, school failure, being bullied, conflict with parents or friends, being expelled from school.

Participants were asked if they had experienced the life event, yes or no. If yes, respondents were asked to rate how stressful the event was from not stressful 0 to very stressful 3. Only adolescents with at least a score of two were included. The amount of Health threats and Relational challenges were both summed into a single score, both items were highly positively skewed. Loss was dichotomous. Missing data were imputed using Relative Mean Substitution [ 53 ]. Descriptive statistics were calculated, and Pearson correlations were computed for all variables included in the models.

Multivariate Analysis of Variance MANOVA was used to test for differences in depressive symptoms and cognitive emotion regulation strategies based on gender or on condition. To examine the correlations between the three stressful life event variables, the nine proposed mediators and the outcome measure of depression, we applied path analyses using the software package MPLUS 7 [ 54 ]. Models were tested first for the whole sample and thereafter separately for participants scoring high versus low on depression using multigroup analyses.

Within the models, the correlation between the three stressful life event variables was taken into account, as well as the correlation between the proposed mediators. The comparative fit index CFI, preferably. To examine the hypothesized mediation of cognitive emotion regulation strategies in the association between the type of stressful life events and depression, we used the Model Indirect approach using MPLUS 7 with a bootstrap procedure to ensure the accuracy and robustness of the analyses and to estimate Type I errors. To assess the possible moderating effect of the level of depression, multi-group analyses were conducted within MPLUS 7. Next, differences between both groups for the relations between model variables were tested per direct path, also using the chi-square difference test.

This was done by constraining each path of interest separately while all other paths were unconstrained, and comparing this model to the model in which the path of interest, as well as all other paths, was unconstrained. This command permitted testing of linear restrictions on the parameters using the Wald chi-square test [ 54 ]. An ANOVA showed no gender differences in depressive symptoms in the total group, nor in the subgroups. A MANOVA using both the total sample and the subgroups showed no differences in cognitive emotion regulation strategies between adolescents who did or did not experience loss.

An ANOVA using both the total sample and the subgroups showed no differences in depressive symptoms between adolescents who did or did not experience loss. Correlations, means and standard deviations for the total sample and all model variables are reported in Table 1 , and separately for depressed and non-depressed adolescents in Table 2. Within the total sample , age did not correlate significantly with depressive symptoms. Health threatening and relational challenging stressful life events showed weak to moderate correlations with depressive symptoms. Except for acceptance, all cognitive emotion regulation strategies, correlated weakly to strongly with the number of depressive symptoms.

Weak to moderate correlations were found for relational challenging stressful life events and seven out of nine cognitive emotion regulation strategies; self-blame, other-blame, catastrophizing, rumination, putting into perspective, positive refocusing and acceptance. Within the non-depressed group , age did not correlate significantly with depressive symptoms. Relational challenging stressful life events were weakly correlated with more depressive symptoms. Weak correlations between relational challenging stressful life events and several strategies were found, namely; self-blame, other-blame, catastrophizing, rumination, positive reappraisal, acceptance and refocus on planning.

Of these strategies, only self-blame, catastrophizing, positive reappraisal and refocus on planning in turn correlated weakly with depressive symptoms. Stressful health threatening life events correlated weakly with other-blame, which did not significantly correlate with depressive symptoms. In the depressed group , age did not correlate significantly with depressive symptoms. Relational challenging and also health threatening stressful life events showed a weak to moderate correlation with the degree of depressive symptoms, as well as with self-blame.

All strategies, except for other-blame and acceptance, were weak to moderately correlated with depression. Multi-group analysis was used to test differences in depression level. The results of the model are described for participants with high and low depression scores separately below see Fig 2 for the model and Fig 3 for the indirect effects. Gender was included in the model, but showed no direct significant effects on depressive symptoms or on any cognitive emotion regulation strategy.

Standardized estimates of the direct effects on the cognitive emotion regulation and depressive symptoms. Loss was not associated with depressive symptoms in the total sample, or in either subgroup. Within the total sample, relational challenging stressful life events were associated with various strategies, namely self-blame, other-blame, catastrophizing, rumination, putting into perspective and acceptance Fig 2. Health threatening stressful life events were not significantly associated with any cognitive emotion regulation strategy within the whole sample, nor within the subgroups.

Within the whole sample more depressive symptoms were significantly associated with: self-blame, catastrophizing, rumination, positive reappraisal and refocus on planning Fig 2. In the depressed group, no significant associations between degree of depressive symptoms and use of any cognitive emotion regulation strategy was found. The correlations between strategies and depressive symptoms did not differ significantly between depressed and non-depressed subgroup. Acceptance was not significantly associated with the degree of depressive symptoms within either subgroup. Within the whole sample, significant indirect paths from relational challenging stressful life events to depressive symptoms were found via self-blame, catastrophizing and rumination Fig 3.

Indirect paths were found in the non-depressed group, from relational challenging stressful life events to depressive symptoms via self-blame and refocusing on planning. Within the depressed group, no indirect paths were identified. However, the Wald test of parameter constraints showed no significant differences between the non-depressed and depressed group for these indirect paths. The findings of this study support the general hypothesis that certain stressful life events were related to the level of depressive symptoms and that this relationship was mediated by maladaptive cognitive emotion regulation strategies. These findings are important for clinical practice to increase understanding of the association between specific types of stressful life events and the use of cognitive emotion regulation strategies.

In addition, the results confirm the dual process model on associative and reflective processing in adolescents and depression [ 30 ]. The important role of self-referent association, maladaptive cognitive emotion regulation strategy namely self-blame, as a mediator of depressive symptoms was confirmed. The main results can be summarized as follows: I Health threatening and relational challenging stressful life events were associated with depressive symptoms, while stressful loss related life events were not; II more frequent use of maladaptive cognitive emotion regulation strategies was related to more depressive symptoms; III more frequent use of adaptive cognitive emotion regulation strategies was related to less depressive symptoms; IV specific life events were associated with specific emotion regulation strategies; V only the association between relational challenging stressful life events and depressive symptoms was mediated by maladaptive cognitive emotion regulation strategies self-blame, catastrophizing and rumination ; and VI adaptive cognitive emotion regulation strategies were not identified as mediators in the total sample.

These results deserve some further interpretation and reflection. The relationship between cognitive emotion regulation strategies and depressive symptoms was established in our study. More use of maladaptive self-blame, catastrophizing, rumination and less use of adaptive cognitive emotion regulation adaptive strategies positive reappraisal, refocus on planning were significantly associated with more depressive symptoms in the whole sample. This finding is in line with earlier findings that maladaptive emotion regulation was linked to the onset of depressive symptoms [ 35 — 39 ]. Maladaptive cognitive emotion regulation could representative of the self-referent association of the dual process model and adaptive cognitive reflection is considered to be of importance for the regulation of emotions.

Deficient emotion regulation is also a risk factor for recurrence of depression [ 40 ]. Our findings suggest that using maladaptive strategies can be more harmful, than the absence of using adaptive strategies. These findings are relevant for clinical practice to enhance prevention and treatment in order to detect and address specific mechanisms at work in depression. One specific and adaptive cognitive emotion regulation strategy, acceptance, was not significantly associated with depressive symptoms, as was also reported in a meta-analysis band colleagues [ 41 ].

Increase of acceptance of a problem or risk is a common objective in various treatments such as Mindfulness, and Acceptance and Commitment Therapy [ 57 ]. In acceptance-based treatments, acceptance is promoted in order to reduce experiential avoidance [ 58 , 59 ]. However, the role of acceptance might differ during the process of handling stressful life events and therefore it might also have been disguised in our study.

A high score on acceptance immediately after a stressful life event could, for instance, be related to learned helplessness. Timing in relation to the occurrence of stressful life events should be taken into account in future research on acceptance. In addition, acceptance may be more of an end state that is based upon other regulation strategies, instead of reflecting an active and dynamic cognitive emotion regulation strategy. Stressful loss was not found to be associated with higher levels of depressive symptoms. This finding that the death of a loved one was generally not associated with elevated levels of depressive symptoms should be interpreted with caution.

Another study found a significant increase in depression in the second year after bereavement [ 65 ]. In our study however, lapse of time after loss could not be accounted for. In a community sample, the comparison between family bereaved and non-bereaved showed a robust difference in internalizing problems by the age of 19 [ 24 ]. No long-term effects could be assessed in the current study. Furthermore, a broad definition of loss was used, which included pets. The kind of loss might also be of importance for the impact on mental health. Health threatening stressful life events were only associated with depressive symptoms in the depressed group and not in the non-depressed group. Although the level of depressive symptoms was high in the depressed adolescents, health threats still accounted for substantially more depressive symptoms.

These findings are in line with a review on depressive symptoms in epileptic youth, showing an elevated risk for depression in this specific group with health problems [ 66 ]. So it seems that health threats are particularly important for depressive symptoms in adolescents. An association between relational challenging stressful life events and depressive symptoms was established for the total sample, and seen in both the depressed as well as the non-depressed group. This association was not found in earlier research conducted with secondary school students [ 67 ]. This discrepancy can be explained by the use of a larger multi-group sample in this study with higher levels of depressive symptoms, which made detection of the association possible.

This shows that the use of multiple samples is indeed important in future research on cognitive emotion regulation [ 41 ]. Our findings confirm the existence of a specific association between relational challenges and cognitive emotion regulation. Loss or health threatening stressful life events showed no specific association with any of the cognitive emotion regulation strategies within the whole group, suggesting that the type of stressful event influenced the use of specific cognitive emotion regulation.

Relational challenging stressful life events were associated with maladaptive strategies as well as with two adaptive strategies: putting experiences into perspective and acceptance. The non-depressed group showed a significant association between relational challenging stressful life events and three adaptive strategies, namely positive reappraisal, refocus on planning, and acceptance. In the depressed group, this association was not found, suggesting that non-depressed and depressed adolescents differ in their use of maladaptive and adaptive cognitive emotion regulation strategies. However, no significant difference between groups in the strength of this association was found. These results must thus be interpreted with caution, and studies with larger groups are needed to rule out power issues in interpreting these differences.

The mediating role of maladaptive cognitive emotion regulation strategies was established, Self-blame, catastrophizing and rumination could be identified as mediators between stressful relational challenging life events and depressive symptoms. However, depressed and non-depressed adolescents did not differ significantly in these mediation relationships, which may be due to the size of the depressed sample. Still, this is an important finding, which could be useful for clinical practice. Experiencing relational challenging stressful life events and blaming oneself, emphasizing the terror of experiences or dwelling on feelings and thoughts about the events, may put adolescents at risk for depressive symptoms.

This study is innovative for several reasons. First, according to the literature, testing mediational models on the etiology of adolescent depression was needed [ 14 ]. Second, the use of the multi-sample approach, including severely depressed adolescent patients, is scarce and should be used more often [ 68 ], as it is essential for the study of psychopathology [ 14 , 41 ]. Third, a rigorous criterion for life events was used, namely stressful life events reported by the adolescent as upsetting. Previous research used the number of life events as a variable, without the upsetting criterion, thereby ignoring whether the life events actually impact the life of participants in a negative fashion.

Fourth, not only being upset but also the type of life event was taken into account as an important variable affecting depressive symptoms, as well as the cognitive emotion regulation strategies. Fifth, to our knowledge, we were the first to test the mediating role of cognitive emotion regulation in the association between stressful life events and depressive symptoms in adolescents and to test differences in mediation between low and high levels of depressive symptoms. This study also has several limitations. First, cross-sectional data were used and therefore no temporal conclusions could be drawn. Future research is needed to test mediational models in a longitudinal design.

Second, the profile of different mediators within one individual could not be taken into account. For example, the mediation of depressive symptoms by rumination may be more prominent if the use of self-blame is high and positive refocusing is low. Even more useful for clinical practice would be the identification of patterns in how the various emotion regulation strategies are used [ 69 ]. Third, the relationship between associative maladaptive strategies and reflective processing adaptive strategies could not be taken into account, while this may be a function of clinical severity [ 41 ]. Further research on specific correlations between cognitive emotion regulation strategies is needed and of importance to determine which strategy should be addressed in interventions.

Fourth, a lack of power could underlie the fact that no mediating paths were found in the depressed group, and that no significant differences in the strength of the mediational paths between the non-depressed and depressed adolescents were found. Fifth, the time between the last stressful life event and the measurement of depressive symptoms was not taken into account. In a longitudinal design this variable should be included because depressive symptoms could increase instantly or gradually after some time, through use of specific cognitive regulation strategies [ 70 ].

Despite the mentioned limitations, our study contributes to current scientific knowledge by showing that depressive symptoms are mediated by maladaptive cognitive emotion regulation strategies self-blame, rumination and catastrophizing uniquely after stressful relational challenging life events. Mediation was not found after losing a loved one or experiencing a health threat. Adaptive cognitive emotion regulation strategies, for instance acceptance, were not identified as mediators. These findings are important for clinical practice. Use of specific maladaptive cognitive regulation strategies after relationally challenging stressful life events can aggravate depressive symptoms.

To prevent depression after negative life events, maladaptive cognitive emotion regulation strategies should be reduced in adolescents. This research is part of the Adolescent Depression study of the University of Utrecht. We also thank the students for collecting data in the community sample. This research is funded by Zonmw- the Dutch Organisation for Health Research and Development, grant number Conceptualization: YS. Data curation: MR YS. Formal analysis: MK MR. Methodology: MK. Project administration: DHMB. Visualization: MR. Writing — original draft: YS. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.

Abstract Background Depression during adolescence is a serious mental health problem. Results Health threats and relational challenging stressful life events were associated with depressive symptoms, while loss was not. Conclusion The association between relational challenging, stressful life events and depressive symptoms was mediated by maladaptive, cognitive emotion regulation strategies.

Introduction Depression during adolescence is a serious problem because of its high prevalence [ 1 — 3 ], considerable burden of disease [ 4 ], suicide risk [ 5 ], other comorbid psychiatric disorders [ 6 ] and the high risk of recurrence [ 5 , 7 ]. Download: PPT. To use the PHQ-9 as a diagnostic aid for major depressive disorder: Question 1 or 2 needs to be endorsed as a 2 or 3. A total PHQ-9 score of 10 points or more has a good sensitivity and specificity for major depressive disorder. To use the PHQ-9 to screen for suicide risk: All positive answers to question 9 and the two additional suicide items must be followed by a clinical interview. To use the PHQ-9 to obtain a total score and assess depressive severity: Add up the numbers endorsed for questions 1 to 9 and obtain a total score.

Note: See Figure 1 for the questionnaire. PHQ Modified for Teens. The presenting sign of major depressive disorder may be insomnia or hypersomnia; weight loss or gain; difficulty concentrating; loss of interest in school, sports, or other previously enjoyable activities; increased irritability; or feeling sad or worthless. When a child or adolescent screens positive using a formal screening tool, such as the PHQ-A, or when he or she presents with symptoms indicating a possible depressive disorder, the primary care physician should assess whether the symptoms are a result of a major depressive episode or another condition that could present with similar symptoms.

To diagnose major depressive disorder, criteria from the Diagnostic and Statistical Manual of Mental Disorders , 5th ed. DSM-5 , must be met and not explained by substance abuse, medication use, or other medical or psychological condition. Some children may develop a cranky mood or irritability rather than sadness. Medical conditions that may present similarly to depression include hypothyroidism, anemia, autoimmune disease, and vitamin deficiency. Laboratory tests that may be helpful in ruling out common medical conditions that could be mistaken for depression include complete blood count; comprehensive metabolic profile panel; an inflammatory biomarker, such as C-reactive protein or erythrocyte sedimentation rate; thyroid-stimulating hormone; vitamin B 12 ; and folate.

Other psychological conditions that may present similarly to major depressive disorder include persistent depressive disorder also called dysthymia and disruptive mood dysregulation disorder. If a child or adolescent has a depressed mood for more days than not for at least one year, the diagnosis may be persistent depressive disorder, which is often treated the same as a major depressive episode e. Symptoms of bipolar disorder, eating disorders, and conduct disorders may also overlap with major depressive disorder.

Children and adolescents may have more than one psychiatric diagnosis concurrently, such as comorbid depression and anxiety. Therefore, a thorough assessment is needed, with possible mental health consultation or referral. Suicide is the second leading cause of death for people 10 to 24 years of age after unintentional injury. In one study, nurses in a pediatric emergency department used the Ask Suicide-Screening Questions ASQ tool to assess suicide risk in adolescents who presented with psychiatric problems. Ask Suicide-Screening Questions Tool to assess for suicidality.

Adapted from National Institute of Mental Health. Suicide risk screening tool. The GLAD-PC guidelines recommend that primary care physicians counsel families and patients about depression and develop a treatment plan that includes setting specific goals involving functioning at home, at school, and with peers. Additionally, a safety plan should be established that limits access to lethal means, such as removing firearms from the home or locking them up.

It should also provide a way for the patient to communicate during an acute crisis e. See Figure 3 for a suggested approach to the management of depression in children and adolescents. Management of depression in children and adolescents. Information from references 43 and Treatment options for children and adolescents with depression include psychotherapy and anti-depressants. Cognitive behavior therapy CBT is a form of talk therapy that focuses on changing behaviors by correcting faulty or potentially harmful thought patterns and generally includes five to 20 sessions. Whereas CBT focuses on cognition and behaviors, interpersonal psychotherapy concentrates on improving interpersonal relationships and typically includes around 12 to 16 sessions. Fluoxetine Prozac and escitalopram Lexapro are the only two medications approved by the U.

Food and Drug Administration to treat major depressive disorder in children and adolescents. Fluoxetine is approved for patients eight years and older, and escitalopram is approved for patients 12 years and older. There are concerns of increased suicidality with the use of fluoxetine and escitalopram in this population. The frequency of monitoring should be based on the individual patient's risk e. Three systematic reviews of randomized controlled trials including children and adolescents with major depressive disorder support the use of fluoxetine as the first-line antidepressant medication. Tricyclic antidepressants, other selective serotonin reuptake inhibitors, and serotonin-norepinephrine reupta ke inhibitors have not been shown to be effective in treating depression in children and adolescents.

Evidence is mixed for the use of CBT as monotherapy in children and adolescents with depression. Children and adolescents with moderate or severe depression or persistent mild depression should be treated with fluoxetine or escitalopram in conjunction with CBT or other talk therapy. One trial found that early reassessment of depression is valuable. If additional treatment was needed because of inadequate response, patients were further randomized to add-on fluoxetine or more intense twice weekly psychotherapy. Those who were reassessed at four weeks improved the most at 16 weeks a difference of 5. Additionally, those who began add-on fluoxetine at four weeks had better posttreatment depression scores than those who began intense interpersonal psychotherapy at eight weeks, although there was no difference in global assessment scores between the two groups.

Treatment duration for talk therapy in adolescents with unipolar depression is typically six months or less, but longer treatment may be necessary. Although good evidence regarding the duration of medication treatment in adolescents with depression is lacking, the GLAD-PC guidelines recommend continuing medication for one year beyond the resolution of symptoms. If a child or adolescent does not improve after initial treatment for depression, the primary care physician may add, change, or increase a medication and may consider referral for psychotherapy.

Referral to a licensed mental health professional is appropriate at any point in the treatment process. However, if the depression does not improve or the child deteriorates even with treatment, consultation with or referral to a child or adolescent psychiatrist is necessary. This article updates previous articles on this topic by Clark, et al. Search dates: November to January , and September 27, Already a member or subscriber? Log in. Interested in AAFP membership? Learn more.

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People are most likely to develop their Depression In Adolescents Case Study depressive episode between the ages of Depression In Adolescents Case Study and 40, and there is a Depression In Adolescents Case Study, smaller peak of incidence between ages 50 and Pathways to lifespan health following Fate And Free Will In Shakespeares Romeo And Juliet parental Medication Errors In The Emergency Department. The mediating role of maladaptive cognitive emotion regulation strategies was established, Self-blame, catastrophizing and rumination could be identified as mediators between stressful relational challenging life events and depressive symptoms. Two-year longitudinal study of poststroke mood disorders: diagnosis and Depression In Adolescents Case Study at one and two years. Four studies recruited adolescents from school settings and compared the screening test with a diagnostic interview or a different screening test. Biological Psychiatry. The FDA has issued a boxed warning for antidepressants, recommending Depression In Adolescents Case Study patients of all ages who start Depression In Adolescents Case Study therapy be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior.

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