2. Medication 2 Epidemiology Diagnosis Psychotherapy Medication 10 20 30 40 50 40 30 20 10 50 40 30 20 10 50 40 30 20 10 50 40 30 20 10

3. QUESTION: What happens to the risk of depression with age ANSWER: Increases

4. QUESTION: At the age of 14, is depression more common in males or females? ANSWER: M<F 1:2

5. QUESTION: What is the rate of Male-female ratio of depression during childhood? ANSWER: 1:1 Although some reports higher rates among males during childhood

6. QUESTION: Lifetime prevalence of depression in adolescents is: 2-4% 11% 23% ANSWER: 11% Major depression in the national comorbidity survey-adolescent supplement: prevalence, correlates, and treatment. Avenevoli S, Swendsen J, He JP, Burstein M, Merikangas KR J Am Acad Child Adolesc Psychiatry. 2015 Jan;54(1):37-44.e2. Epub 2014 Oct 29.

7. QUESTION: Name 5 risk factors for depression ANSWER: Low birth weight Family history of depression and anxiety Family dysfunction, caregiver –child conflict, abuse, neglect Gender dysphoria and homosexuality h/o anxiety, substance use, learning disabilities, ADHD, ODD Traumatic brain injury Chronic illness, malnutrition Biological Developmental Psychosocial

8. QUESTION: How long should the symptoms last in order to qualify as a major depressive disorder according to the DSM 5? ANSWER: 2 weeks

9. QUESTION: How many symptoms should be present in order to diagnose MDD according to the DSM-5? ANSWER: 5 or more symptoms should be present at the same 2 weeks and represent a change from previous functioning. At least one of the symptoms should be depressed mood or loss of interest or pleasure

10. QUESTION: Name at least 4 symptoms that can count as a criteria for MDD ANSWER: Depressed mood Loss of interest or pleasure Significant unintended weight loss or weight gain Insomnia/hypersomnia Psychomotor retardation/agitation Fatigue Feelings of worthlessness or excessive guilt Diminished ability to think or concentrate, indecisiveness Recurrent thoughts of death/suicidal ideation

11. QUESTION: Name one screening tool for depression in the primary care setting ANSWER: BDI Beck Depression Inventory (21 questions scores 0-63) PHQ9 Patient Health Questionnaire (9 quest. scores 1-27) CDI Children’s depression inventory (27 quest. 0-54) CES-D Center for epidemiologic studies depression scale (20 quest. 0-60) RADS-2 Reynolds Adolescent depression scale (30 quest.30-120)

12. QUESTION: Name 2 differential diagnoses for depression in adolescents ANSWER: Adjustment disorder Bipolar disorder Sadness Bereavement Anxiety

13. QUESTION: Which psychosocial treatments are available for depression? ANSWER: Cognitive behavioral therapy Interpersonal therapy for adolescents Family therapy Dynamic therapy Group therapy

14. QUESTION: Which psychosocial treatments were proven to be efficacious for adolescents? ANSWER: CBT IPT-A

15. QUESTION: Which psychotherapy treatment is based on the assumption that independent of the cause, depression is associated with relationship disruption? IPT-A CBT DBT ANSWER: Interpersonal Psychotherapy for Adolescents (IPT-A). Focuses on relationship problems associated with the adolescent’s depression

16. QUESTION: Anna is a 19 y.o. with a personality disorder recurrent admission for depression and suicidality in the past 6 years which psychotherapy would not be recommended for her? ANSWER: IPT-A is not recommended for adolescents with a long- standing history of severe interpersonal dysfunction

17. QUESTION: Cognitive Behavioral Therapy is aiming to create therapeutic changes in both thoughts and behaviors. In the list below decide if the target is cognitive or behavioral: Perfectionism Cognitive Poor sleep hygiene Behavioral Poor perception about the world Cognitive Sedentary lifestyle Behavioral Poor social skills Behavioral

18. QUESTION: Match the group of medications to their generation Atypical antidepressants MAO inhibitors SSRI SNRI Tricyclic Serotonin modulators First generation Second generation

19. QUESTION: How long should the patient continue the medication post remission of symptoms? ANSWER: 6-12 months

20. QUESTION: Match the medication to the group 1.SSRI 2.SNRI 3.Atypical antidepressants 4.Serotonin modulators ANSWER: 1-A 2-D 3-B 4-C A.Prozac- fluoxetine B.Mirtazapine C.Nefazodone D.Venlafaxine

21. QUESTION: What is recommended as a first line treatment for adolescent unipolar depression? ANSWER: SSRI- Fluoxetine

22. QUESTION: What can we learn from the TORDIA study ANSWER: That when depression is resistant to one SSRI it is better to switch to another SSRI than switching to SNRI

23. QUESTION: What are the most common side effects of SSRI ANSWER: – Abdominal pain – Agitation, jitteriness, or akathisia (restlessness and inability to sit still) – Diarrhea – Headache – Nausea – Sleep changes

24. QUESTION: What is the benefit of Prozac over Zoloft in non adherent patients? ANSWER: Longer T 1/2

25. QUESTION: TADS study assessed response to psychotherapy versus pharmacotherapy or combination for the treatment of depression. What is more efficient? ANSWER: The Treatment for Adolescent with Depression Study After 12 weeks of treatment – Combined therapy: 71% – Fluoxetine alone: 60.6% – CBT: 43.2% After 36 weeks of treatment – Combined therapy: 86% – Fluoxetine: 81% – CBT: 81%

26. QUESTION: Liz was treated with Sertraline 200 mg, she feels much better now and decides to save the money for a new dress rather than buying medications. Which symptoms might develop if she abruptly discontinue the medication ANSWER: Withdrawal syndrome: anxiety, chills, dizziness, fatigue, myalgia, nausea

27. QUESTION: Josh received a new medication that helped, today though he is feeling weird-sweating, shivering, his heart is racing at a rate of 120, he is anxious and warm to touch. Do you have an idea of what could have happened? ANSWER: Serotonin syndrome is a potentially lethal condition caused by overstimulation of central and peripheral serotonin receptors. Clinical features include anxiety, agitation, delirium, diaphoresis, tachycardia, hypertension, hyperthermia, gastrointestinal distress, tremor, muscle rigidity, myoclonus, and hyperreflexia