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Journal of the American Academy of Child & Adolescent Psychiatry

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Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders - 12/08/11

Doi : 10.1097/chi.0b013e318145ae1c 
Boris Birmaher, M.D., David Brent, M.D. : Principal Authors

The AACAP Work Group on Quality Issues


ABSTRACT

This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.

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Key Words : major depressive disorder, dysthymic disorder, evaluation, treatment, antidepressants, selective serotonin reuptake inhibitors, psychotherapy, practice parameter


Plan

METHODOLOGY
DEFINITIONS
EPIDEMIOLOGY
CLINICAL PRESENTATION
COMORBIDITY
DIFFERENTIAL DIAGNOSIS
CLINICAL COURSE
COMPLICATIONS
RISK FACTORS
EVIDENCE BASE FOR PRACTICE PARAMETERS
CONFIDENTIALITY
Recommendation 1. The Clinician Should Maintain a Confidential Relationship With the Child or Adolescent While Developing Collaborative Relationships With Parents, Medical Providers, Other Mental Health Professionals, and Appropriate School Personnel [MS].
SCREENING
Recommendation 2. The Psychiatric Assessment of Children and Adolescents Should Routinely Include Screening Questions About Depressive Symptomatology [MS].
EVALUATION
Recommendation 3. If the Screening Indicates Significant Depressive Symptomatology, the Clinician Should Perform a Thorough Evaluation to Determine the Presence of Depressive and Other Comorbid Psychiatric and Medical Disorders [MS].
Recommendation 4. The Evaluation Must Include Assessment for the Presence of Harm to Self or Others [MS].
Recommendation 5. The Evaluation Should Assess for the Presence of Ongoing or Past Exposure to Negative Events, the Environment In Which Depression Is Developing, Support, and Family Psychiatric History [MS].
TREATMENT
Recommendation 6. The Treatment of Depressive Disorders Should Always Include an Acute and Continuation Phase; Some Children May Also Require Maintenance Treatment [MS].
Recommendation 7. Each Phase of Treatment Should Include Psychoeducation, Supportive Management, and Family and School Involvement [MS].
Recommendation 8. Education, Support, and Case Management Appear to Be Sufficient Treatment for the Management of Depressed Children and Adolescents With an Uncomplicated or Brief Depression or With Mild Psychosocial Impairment [CG].
Recommendation 9. For Children and Adolescents Who Do Not Respond to Supportive Psychotherapy or Who Have More Complicated Depressions, a Trial With Specific Types of Psychotherapy and/or Antidepressants Is Indicated [CG].
Recommendation 10. To Consolidate the Response to the Acute Treatment and Avoid Relapses, Treatment Should Always Be Continued for 6 to 12 Months [MS].
Recommendation 11. To Avoid Recurrences, Some Depressed Children and Adolescents Should Be Maintained in Treatment for Longer Periods of Time [CG].
Recommendation 12. Depressed Patients With Psychosis, Seasonal Depression, and Bipolar Disorder May Require Specific Somatic Treatments [CG].
Recommendation 13. Treatment Should Include the Management of Comorbid Conditions [MS].
Recommendation 14. During All Treatment Phases, Clinicians Should Arrange Frequent Follow-up Contacts That Allow Sufficient Time to Monitor the Subject’s Clinical Status, Environmental Conditions, and, If Appropriate, Medication Side Effects [MS].
Recommendation 15. During All Treatment Phases, for a Child or Adolescent Who Is Not Responding to Appropriate Pharmacological and/or Psychotherapeutic Treatments, Consider Factors Associated With Poor Response [MS].
PREVENTION
Recommendation 16. Children With Risk Factors Associated With Development of Depressive Disorders Should Have Access to Early Services Interventions [CG].
PARAMETER LIMITATIONS

 This parameter was developed by Boris Birmaher, M.D., and David Brent, M.D., principal authors, and the AACAP Work Group on Quality Issues: William Bernet, M.D., Oscar Bukstein, M.D., and Heather Walter, Co-Chairs, and R. Scott Benson, M.D., Allan Chrisman, M.D., Tiffany Farchione, M.D., Laurence Greenhill, M.D., John Hamilton, M.D., Helene Keable, M.D., Joan Kinlan, M.D., Ulrich Schoettle, M.D., and Saundra Stock, M.D. AACAP Staff: Kristin Kroeger Ptakowski and Jennifer Medicus.
The authors acknowledge the following experts for their contributions to this parameter: Jeffrey Bridge, Ph.D., Amy Cheung, M.D., Greg Clarke, Ph.D., Graham Emslie, M.D., Philip Hazell, M.D., Stan Kutcher, M.D., Laura Mufson, Ph.D., Kelly Posner, Ph.D., Joseph Rey, M.D., Karen Wagner, M.D., and Elizabeth Weller, M.D.
This parameter was made available for review to the entire AACAP membership in February and March 2006.
From July 2006 to February 2007, this parameter was reviewed by a Consensus Group convened by the Work Group on Quality Issues. Consensus Group members and their constituent groups were as follows: Work Group on Quality Issues (Oscar Bukstein, M.D., Helene Keable, M.D., and John Hamilton, M.D.); Topic Experts (Graham Emslie, M.D., and Greg Clarke, Ph.D.); AACAP Assembly of Regional Organizations (Syed Naqvi, M.D.); and AACAP Council (David DeMaso, M.D., and Michael Houston, M.D.).
Disclosures of potential conflicts of interest for authors and Work Group chairs are provided at the end of the parameter. Disclosures of potential conflicts of interest for all other individuals named above are provided on the AACAP Web site on the Practice Information page.
This practice parameter was approved by the AACAP Council on June 1, 2007.
This practice parameter is available on the Internet (www.aacap.org).
Reprint requests to the AACAP Communications Department, 3615 Wisconsin Avenue, NW, Washington, DC 20016
Disclosure: Dr. Birmaher participates or has participated in forums for Solvay Pharmaceuticals, Inc., and Abcomm, Inc., and receives royalties from Random House. Dr. Bukstein receives or has received research support, acted as a consultant to, and/or served on the speakers’ bureaus of Cephalon, Forest, McNeil Pediatrics, Shire, Eli Lilly, and Novartis. Drs. Brent, Bernet and Walter have no financial relationships to disclose.


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Vol 46 - N° 11

P. 1503-1526 - novembre 2007 Retour au numéro
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