Current Management of Depression and Anxiety in Children and Adolescents

The Current Management of Depression and Anxiety in Children and Adolescents Stephen Grcevich, M.D. Child and Adolescent Psychiatry The Family Center by the Falls Chagrin Falls, Ohio President, Board of Directors Key Ministry Foundation Presented at Fairview Hospital/CCF Health System Cleveland, Ohio June 12, 2009 ,[object Object],[object Object]

Educational Objectives: ,[object Object],[object Object],[object Object],[object Object],[object Object]

Potential Conflicts of Interest 2008-09: (Complete disclosure as % of annual income available upon request) Pharmaceutical Industry Consulting: Shire US (100% of compensation donated to charity in 2008) Grant/Research Support Child and Adolescent Psychiatry Trials (CAPTN) Network-ASK, NOTA studies funded through NIMH Speakers’ Bureaus None since 2006 Other Financial/Material Support Web MD/Medscape Leerink-Swann Major Shareholder None

Age-appropriate fears in children: ,[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(2):267-283

Specific Anxiety Disorders in Children, Adolescents: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(2):267-283

Anxiety: Red Flag Signs and Signals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(2):267-283

Epidemiology of Anxiety Disorders: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(2):267-283

MDD Diagnostic Criteria: DSM-IV ,[object Object],[object Object],[object Object],[object Object],DSM IV-TR, American Psychiatric Association

Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(11):1503-1526

Need to Recognize Developmental Variations of MDD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(11):1523-1546

Comorbidity and Depression in Children and Adolescents: ,[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(11):1523-1546

Time Course of Depression in Kids: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(11):1523-1546

Differential Diagnosis of Depression: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(11):1523-1546

Conditions associated with/mistaken for anxiety disorders in kids: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007;46(2):267-283

Treatment options for depression: ,[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry, 2007; 46(11):1503-1526

Treatment of anxiety disorders in children, adolescents: ,[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry , 2007; 46(2):267-283

Medications Used in Kids With Anxiety Disorders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry 2007; 46(2) 267-283

CAMS (Child-Adolescent Anxiety Multimodal Study): ,[object Object],[object Object],[object Object],[object Object],Walkup JT et al, N Engl J Med, 2008;359:2753-2766

CAMS (Child-Adolescent Anxiety Multimodal Study): ,[object Object],[object Object],[object Object],[object Object],[object Object],Walkup JT et al, N Engl J Med, 2008;359:2753-2766

Indications for Pharmacotherapy in AACAP Practice Parameters for Depression: ,[object Object],[object Object],[object Object],[object Object],J Am Acad Child Adolesc Psychiatry , 2007; 46(11):1503-1526

Published double-blind, placebo-controlled studies: SSRI efficacy for MDD in youth ,[object Object],[object Object],[object Object],[object Object],[object Object],Emslie GJ et al, J Am Acad Child Adolesc Psychiatry 2009;48(7):721-729

Metanalysis of Randomized Trials of SSRIs: ,[object Object],[object Object],[object Object],[object Object],Bridge JA et al, JAMA 2007; 297(15):1683-1696

Metanalysis of Randomized Trials of SSRIs: ,[object Object],[object Object],[object Object],[object Object],[object Object],Bridge JA et al, JAMA 2007; 297(15):1683-1696

Why does fluoxetine perform better than other SSRIs in MDD?: ,[object Object],[object Object],[object Object],[object Object],Bridge JA et al, JAMA 2007; 297(15):1683-1696

Combination Treatment of MDD ,[object Object],[object Object],[object Object],[object Object],March J et al. J Am Acad Child Adolesc Psychiatry, 2006;45(12):1393-1403

Treatment Resistant Study ,[object Object],[object Object],[object Object],Brent D et al, JAMA, 2008;299(8):901-913

TORDIA Results: ,[object Object],[object Object],[object Object],Brent D et al, JAMA, 2008;299(8):901-913

The FDA and Antidepressants for Kids: ,[object Object],[object Object],[object Object]

Slide courtesy of David Fassler, MD

Current FDA position ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cognitive Behavioral Therapy (CBT) ,[object Object],[object Object],[object Object],[object Object]

Challenges affecting response to CBT: ,[object Object],[object Object],[object Object],[object Object]

Classroom-based accommodations, interventions: ,[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object],[object Object],[object Object]

Additional Resources: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Question 1: Which of the following steps would not be appropriate for a PCP evaluating a 12 year old with insomnia and school refusal: ,[object Object],[object Object],[object Object],[object Object]

Question 2: Which of the following medications are approved for use in the pediatric population by the FDA? ,[object Object],[object Object],[object Object],[object Object]

Question 3: Which of the following statements about the TADS study is true ? ,[object Object],[object Object],[object Object],[object Object]

Question 4: Which of the following statements is false : ,[object Object],[object Object],[object Object],[object Object]

Question 5: All of the following statements about the CAMS study for anxiety in children and teens are true except : ,[object Object],[object Object],[object Object],[object Object]

Answers ,[object Object],[object Object],[object Object],[object Object],[object Object]

Current Management of Depression and Anxiety in Children and Adolescents

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Current Management of Depression and Anxiety in Children and Adolescents