Notes from the Association of Medical School Pediatric Department Chairs, Inc.
Treating pediatric depression in primary care: Coping with the patients’ blue mood and the FDA’s black box

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Characteristics of pediatric depression

The symptoms of depression change with development.5 Depressed preschoolers often exhibit irritability, apathy, and regression. School-age children may display sad or irritable mood, crying spells, and lack of pleasure. These depressed children are more likely to complain of somatic symptoms, such as headaches, than older children.6 In contrast to depressed adults who frequently complain of sad mood, depressed adolescents often are intensely mood reactive, irritable and sensitive to criticism.

Treatment of pediatric depression

Psychotherapy is a standard initial treatment for juvenile depression, and pediatricians often refer patients for counseling. CBT has been the most studied psychotherapy for pediatric depression, demonstrating benefit in pediatric patients with Major Depressive Disorder, both alone and in combination with antidepressant medications.15

Although pediatricians are unlikely to provide formal CBT to their patients, CBT techniques can be incorporated, and often alleviate depressive/suicidal and

Monitoring of antidepressants in pediatric patients

The FDA black box warning suggested vigilant monitoring of patients started on antidepressants based on a statistically significant increase in suicidality following analysis of 4,000 children in drug trials, although there were no completed suicides in any of these trials.1 FDA recommendations20 for monitoring pediatric patients receiving antidepressants were derived from the TADS (Treatment of Adolescent Depression Study) protocol. The FDA recommended that patients placed on antidepressants,

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