Notes

Outline

Treatment of Depression A Multimodal Approach

Mild to moderate depression Psychotherapy first Add medication if there is partial or no response to therapy

Severe Depression

Psychotherapy Individual Family Group Guidance Education

Types of Therapy Cognitive-behavioral Psychodynamic Interpersonal therapy Structural Strategic Others

Planning for termination or maintenance phase Often this is neglected High incidence of relapse Parents, other authority figures, child make up lists of “early warning signs.” Plan early response for relapse Do it in a positive, affirming way

Medication for Depression SSRIs Bupropion Nefazodone Tricyclics Bright light therapy

Selective Serotonin Reuptake Inhibitors Luvox (fluvoxamine) Zoloft (sertraline) Paxil (paroxetine) Prozac (fluoxetine) off label for under 18 Celexa (citalopram) off label for under 18

SSRI Side Effects Interactions with other medications Sedation Activation Headache GI disturbance Appetite Sexual functioning

Bupropion Can cause jitteriness Helps with AD/HD too Dopamine and norepinephine Off-label for pediatric use

Nefazodone Off-label for pediatric use Some promising studies Minimal weight gain Minimal effect on sexual functioning

Tricyclic Antidepressants Also helpful for AD/HD, bedwetting Cardiac rhythm changes-monitoring necessary Other side effects Dry mouth, dizziness, constipation, sedation