Adolescent Depression

Transcription

1 Adolescent Depression Jamie Steinert, RN, FPMHNP With thanks to Barbara Johnson, PhD, RN, PMHNP Kim Schenk, LMSW Meera Beharry, MD, FAAP Objectives Recognize three risk factors for depression in the adolescent population. Indicate five signs and symptoms of depression in adolescents Recognize three recommendations in the clinical practice guidelines and current research for the treatment of depression in this population 1

2 Chocolate Rewards It s been proven that children, adolescents, or adults experience more stress? Yes! Adolescents They have more external stressors such as less control, and uncertain futures Shift in circadian rhythm. Need 9.5 hours sleep, most get 7 hours or less Biologic hormonal shift associated with increase in baseline cortisol levels 2

3 Brief Review of Adolescence Transition from child to adult Physical maturation - puberty Social maturation Emotional maturation 3

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5 New data Dr. Jay Giedd and MRI Brain develops until 25 years old e/article/0,9171,994126,00.html 5

6 Chocolate Rewards When did we think the brain was fully developed prior to Dr. Geidd s work? Yes! Age 12 Formal Operations according to Piaget reached by age 12 6

7 MRI v. fmri MRI- shows blood flow patterns in the brain fmri- Many MRI images taken quickly together in time MRI = picture fmri = movie Structures of Significance Pre-frontal Cortex Executive Function Amygdala emotion and associated memory Nucleus accumbens motivation/reward/punishment Cerebellum co-ordination/balance 7

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9 Myelin Oligodendrocyte makes the myelin for axons in brain Node of Ranvier is left uncovered Saltatory ( jumping ) conduction Gray Matter v. White Matter Gray Matter White matter 9

10 Growth and Pruning Findings Growth and Pruning Second trimester of gestation Late Adolescence Difference In utero birth and pruning of new cells Adolescent growth and pruning of new synapses 10

11 Process: Growth Spurt Between age 6-12 a growth spurt of synaptic elaboration-gray matter Brain growth is independent of body growth Girls peak = 11 Boys = 12.5 By the end of childhood the brain has 1,000,000,000,000,000 connections Process: Pruning Puberty to 25 years old- unused gray matter dies White matter thickensincreasing transmission of information 11

12 Supporting Data Dr. Nitin Gogtay brain mapping to show 17 years of brain development over a few seconds Results: Pre-frontal cortex is last to develop Increased density of dopamine connections in pre-frontal cortex increases capacity to learn in response to reward Brain Development 12

13 Lizard Brain v. Wizard Brain Limbic system: amygdala/hippocampus Pre-frontal cortex 13

14 Data Implications Brain with great potential at the beginning of puberty Which synaptic pathways develop and strengthen depend on exposure and experience Late development of reasoning Questions or comments? 14

15 Moving on to Depression Risk Latino Youth At Risk Migration Stressors increased risk of depression and anxiety Time in the US and support from family and teachers reduced the risk of depression and anxiety Risk of depression with Family documentation status 15

16 Latino Youth At Risk CDC (2007) National Survery found 40% more likely to feel sad or hopeless; attempt suicide; commit suicide In Latino youth depression and anxiety positively correlated with suicidal behavior Depressed adolescents more likely to commit suicide Ethnic Differences in Teens Hispanic Americans (HA) SI more likely HA and Asian American more likely to have social stress 16

17 At Risk for Depression Offspring of depressed parents 2 to 4 times more likely female gender both parents affected history parental suicide Pre-existing anxiety or behavior disorder At Risk for Depression Female Interpersonal relationships - girls Changing schools or getting poor grades - boys Chronic stress 17

18 Detecting Depression Affects adolescents more than children Difficult to diagnose due to co-occurring disorders Marked increase in depressive symptoms around age 13 Peak ages for onset are between Clinical Features Agitation Anxiety Attention difficulties Distraction Defiant and oppositional behaviors 18

19 Symptoms vary with age and sex Ages Anxiety School refusal Headaches and stomachaches Symptoms vary by age and sex Ages Mood and thinking more likely to be affected anhedonia, negative thinking Boys may be more prone to anger, acting out, risktaking behaviors or obsession with school work Girls may be more prone to tearfulness, apathy, social isolation, weight gain or loss eptember/references_for_8220school-based_safety_interventions

20 ADHD Attention Deficit Hyperactivity Disorder Prevalence of 2-14% Must be differentiated from other causes of inattention and hyperactivity pmc/articles/pmc / Substance use Many substances that are commonly used by adolescents effect the dopaminergic pathway Adolescent brain may be particularly vulnerable to effects NIDA 20

21 So how do the meds help kids with ADHD? Patients with ADHD have lower dopamine levels compared to kids without ADHD. Therefore, the stimulant medications affect them differently. Trauma Adverse Childhood Events Deficits in: IQ memory, working memory attention response inhibition emotion discrimination Deficits in brain volume, gray and white matter of several regions, most notably, the frontal cortex 21

22 Data Implications ABA recommends all states ban death penalty for minors Teenagers need parents/older adults to guide them Teenagers are greatly affected by their environment Data Implications Pediatricians may see patients up to age 25 Many research opportunities in effects of chemicals on developing brain Effects of programs? New view of mental illness Perhaps learning how to reverse changes Reward focused 22

23 Take Home Points Adolescent Brains are Works in Progress Lizard Brain to Wizard Brain Neurons that Fire Together, Wire together Resources World News: National Institute of Mental Health: Society for Adolescent Health and Medicine: International Association for Adolescent Health: 23