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epidemiology of depression in children
- after puberty--risk increases 2-4 times
- gender differences--more in women
- incresae risk for depression among girlrs--sychosocial worry about body image, biological, physical/emotional trauma
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how do you recognize MDD in 3-4 year olds
- anxiety, social withdrawal
- language skill development decline
- decreasd activity
- eating or sleeping difficulties
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how doy ou recognize MDD in 5-12 year olds
- sadness, low self esteem, guilt/self blame
- pyshcial complaints--stomach aches
- activing out behaviors--school problmes, lying, stealing, tantrums
- accident pronesness
- auditory hallucinations
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what are adolescent symptoms of mdd in adolescents
- irritability, sadness, anxiety apthathy
- anhdonia
- helpless ness, sleep and appetite changes
- socila withdrawal
- acting out behaviors
- substance abuse
- delusions
- suicidal ideations and attempts
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treatment approaches
fluoxetine, citalopram, sertraline 1*
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how do you treat non responders
- patient does nto respond--add CBT or switch to alternative, sertraline, italopram, escitalopram
- patietn does nto respond to the above txm --augment lithium, bupropion mirtazapine
- non response to augmentation
- bupropion, mirtazapine, duloxetine, venlafacine, fule out medical comorbidities and med adherance
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