Pediatric emergency medicine trisk 4189 4189
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Symptoms of depression during adolescence are more similar to those
seen in adult-onset depression. The major symptom is a sad, unhappy or
irritable mood, and/or a pervasive loss of interest and pleasure. Other
symptoms may include a change in appetite, change in a sleep behavior, and
psychomotor retardation or agitation. Also present in many depressed
teenagers are loss of energy, feelings of worthlessness or excessive guilt,
decreased ability to concentrate, indecisiveness, and recurrent thoughts of
death or suicide. Depressed teenagers can also present with somatic
complaints, academic problems, promiscuity, drug or alcohol use, aggressive
behavior, and stealing. Many teenagers with behaviors such as these are
unaware of their depression, others simply deny it. In talking with these
patients about their lives at home, at school, and with peers, the underlying
depression usually becomes apparent.
A medical evaluation is needed to rule out potential medical causes,
concurrent medical illness, and to assess for self-injurious/suicidal behaviors
and side effects of prescribed medications. See Table 126.2 .
The AACAP Depression Resource Center can be accessed at
/>ression_Resource_Center/Depression_Resource_Center.aspx .
Management
The major goals in the management of depression in the ED involve (i)
determining suicidal risk (ii) uncovering acute precipitants, (iii) making an
appropriate disposition, and (iv) creating a safety plan.
ED physicians should screen for the presence of suicidal ideation as well
as any history of prior attempts. Direct questions about suicidal thoughts are
critical. They are unlikely to catalyze suicide attempts and may actually
provide a sense of relief for the depressed child.
The physician should attempt to determine possible acute precipitants to
guide subsequent recommendations. The duration of the depression should
be determined as well as the family’s response. Assessing overall adjustment
at home, in school, and with peers is important, as well as looking for the
strengths of child and family for use in the treatment plan.
Outpatient management may be considered when adequate social support
is present. Parental acknowledgment of the severity of and risk associated
with their child’s symptoms as well as a strong commitment to participating
