Adolescents depressive disorders

Suicidaiity in chiidren and adoiescents Antidepressants increased the risk of suicidal thinking and behavior (suicidaiity) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone... 

Suicidality in children and adolescents Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of trazodone or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Trazodone not approved for use in pediatric patients (see Clinical worsening and suicide risk and Children sections in Warnings). 

In this chapter we review extant data on the neurobiology of unipolar and bipolar depressive disorders in children and adolescents. A complement to two recent reviews (Kaufman and Ryan, 1999 Kaufman et ah, 2001), this chapter places primary emphasis on those studies in which neuroimaging techniques have been used. Unfortunately, such studies are few and far between. Preclinical models that have guided research on the neurobiology of affective disorders in adults are discussed, and, given the limits in the application of these models to juvenile samples, especially in the case of unipolar disorder, the need for more developmentally focused preclinical work is emphasized. 

Limitations in the Application of Preclinical Models of Effects of Stress in Organizing Neurobiological Correlates of Major Depressive Disorder in Children and Adolescents... 

Unipolar and bipolar depressive disorders in children and adolescents are serious conditions. The pathophysiology of these disorders is poorly understood. The new tools available through neuroimaging techniques will help to unravel the neuroanatomical systems involved in the onset and recurrence of these disorders. There is a need for more developmentally informed predinical research and more studies of the normal development of the neural systems implicated in emotional regulation. 

Kaufman, J. (1991) Depressive disorders in maltreated children. / Am Acad Child Adolesc Psychiatry 30 257-265. 

Ryan, N., and Dahl, R. (1993) The biology of depression in children and adolescents. In Mann, J. and Kupfer, D., eds. The Biology of Depressive Disorders. New York Plenum Press, pp. 37-58. 

Tutus, A., Kibar, M., Sofuoglu, S., Basturk, M., and Gonul, A.S. (1998) A technetium-99m hexamethylpropylene amine oxime brain single-photon emission tomography study in adolescent patients with major depressive disorder. Eur J Nucl Med 25 601— 606. 

Pine, D.S., Cohen, P., Pine, D.S., Cohen, P., Gurley, D., Brook, J., and Ma, Y. (1998) The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 55 56—64. 

Emslie, G.J., Armitage, R., Weinberg, W.A., Rush, A.J., Mayes, T.L., and Hoffmann, R.E (2001) Sleep polysomnography as a predictor of recurrence in children and adolescents with major depressive disorder. Int J Neuropsychopharmacol 4 159-168. 

Geller, B., Cooper, T.B., Graham, D.L., Fetner, H.H., Marsteller, F.A., and Wells, J.M. (1992) Pharmacokinetically designed doubleblind placebo-controlled study of nottriptyline in 6- to 12-yeat-olds with major depressive disorder. / Am Acad Child Adolesc Psychiatry 31 34—44. 

Nefazodone is not approved by the FDA for use in children, and the literature on its efficacy in the pediatric population is limited. A small case study of children and adolescents who suffered from treatment-refractory depressive disorders (n = 7 mean age of 12.4) were treated with a mean daily dose of 357 151 mg (3.4 mg/kg) for 13 8 weeks. Over half of the subjects (4/7) were judged to be much to very much improved as rated by the Clinical Global Impression (CGI) (Wilens et al., 1997). More recently, an open-label study of nefazodone in children and adolescents (n = 28) with depression yielded significant improvement in depressive symptoms as measured by the Children s Depression Rating Scale, Revised (Findling et al., 2000). 

Bitmaher, B., Dahl, R.E., Williamson, D.E., Perel, J.M., Btant. D.A., Axelson, D.A., Kaufman. J., Don, L.D., and Still, S. (2000) Growth hormone secretion in children and adolescents at high risk for major depressive disorder. Arch Gen Psychiatry 57 867-872. 

Birmaher, B. (1998) Should we use antidepressant medications for children and adolescents with depressive disorders Psychophar-macol Bull 34 35-39. 

Birmaher, B., Brent, D.A., and Benson, R.S. (1998) Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. American Academy of Child and Adolescent Psychiatry. / Am Acad Child Adolesc Psychiatry 37 1234-1238. 

Gammon, G.D. and Brown, T.E. (1993). Fluoxetine and methylphenidate in combination for treatment of attention deficit disorder and comorbid depressive disorder. / Child Adolesc Psychopharmacol 3 1-10. 

Major depressive disorder (MDD) is a familial recurrent illness associated with poor psychosocial and academic outcome an increased risk for other psychiatric disorders, suicide, and suicide attempts and a high rate of depression and psychological difficulties in adult life (Birmaher et ah, 1996b Goodyer et ah, 1997 Lewin-sohn et ah, 1999 Pine et ah, 1998 Rao et ah, 1999 Weissman et ah, 1999a,b). The prevalence of MDD in children and adolescents is approximately 2% and 6%, respectively (Birmaher et ah, 1996b). Thus, early identification and prompt treatment of this disorder at its early stages is critical. 

Birmaher, B., Brent, D.A., Kolko, D., Baugher, M., Bridge,/., Holder, D., Iyengar S., and Ulloa, R.E (2000a) Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder. Arch Gen Psychiatry 57 29—36. 

Clarke, G.N., Hawkins, W, Murphy, M., Sheerer, L.B., Lewiston, P.M., and Seeley, J.R. (1995) Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents a randomized trial of a group cognitive intervention. / Am Acad Child Adolesc Psychiatry 34 312-321. 

Hughes, C.W, Emslie, G.J., Crismon, M.L., Wagner, K.D., Birmaher, B., Geller, B., Pliszka, S., Ryan, N., Strober, M., Trivedi, M.H., Toprac, M.G., Sedillo, A., Liana, M.E., Lopez, M., Rush, A.J., and Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder (1999). The Texas childhood medication algorithm project report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. / Am Acad Child Adolesc Psychiatry 38 1442-1454. 

Klein, D.N., Lewinsohn, P.M., Seeley, J.R., and Rohde, P. (2001) A family study of major depressive disorder in a community sample of adolescents. Arch Gen Psychiatry 58 13-20. 

Strober, M., Lampert, C., Schmidt, S., and Mottell, W. (1993) The course of major depressive disorder in adolescents I. Recovery and risk of manic switching in a follow-up of psychotic and nonpsychotic subtypes. J Am Acad Child Adolesc Psychiatry 32 34 2. 

Wood, A., Harrington, R., and Moore, A. (1996) Controlled trial of a brief cognitive-behavioral intervention in adolescent patients with depressive disorders. / Child Psychol Psychiatry 37 737-746. 

High levels of aggression have been reported in adolescents with major depressive disorder (MDD) (Knox et al., 2000). Delinquent youth and youth with CD have high rates of affective illness (Puig-Antich 1987 Pliszka et al., 2000). Children and adolescents suffering from both MDD and antisocial behavior are at highest risk for suicidal acts (Brent et al., 1993). 

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