Child and adolescent depression: psychotherapeutic, ethical, and related nonpharmacologic considerations for general psychiatrists and others who prescribe

Major challenges in youth psychopathology: treatment-resistant depression. A narrative review

Major depressive disorder (MDD) represents a major health issue in adolescents and young adults, leading to high levels of disability and profoundly impacting overall functioning. The clinical presentation of MDD in this vulnerable age group may slightly differ from what can be observed in adult populations, and psychopharmacological strategies do not always lead to optimal response. Resistance to antidepressant treatment has a prevalence estimated around 40% in youths suffering from MDD and is associated with higher comorbidity rates and suicidality. Several factors, encompassing biological, environmental, and clinical features, may contribute to the emergence of treatment-resistant depression (TRD) in adolescents and young adults. Furthermore, TRD may underpin the presence of an unrecognized bipolar diathesis, increasing the overall complexity of the clinical picture and posing major differential diagnosis challenges in the clinical practice. After summarizing current evidence on epidemiological and clinical correlates of TRD in adolescents and young adults, the present review also provides an overview of possible treatment strategies, including novel fast-acting antidepressants. Despite these pharmacological agents are promising in this population, their usage is expected to rely on risk-benefit ratio and to be considered in the context of integrated models of care.

Medical decision-making for adolescents with depression: A bibliometric study and visualization analysis via CiteSpace

This study focussed on evaluating the status of recent research on medical decision-making for adolescents with depression and identifying research hotspots and frontiers via CiteSpace. We extracted studies that were concerned with medical decision-making for adolescents with depression from the Web of Science Core Collection (WoSCC), covering the period from 1 January 1999 to 20 September 2022. We used CiteSpace to generate online maps of worldwide cooperation among countries, institutions, and authors. Hotspots and frontiers were systematically summarized. A total of 368 papers related to medical decision-making for adolescents with depression were obtained from WoSCC. The most prolific author was Nick Midgley (seven papers). The United States and University College London were the leading country and institution in this research area, with 177 and 17 papers, respectively. Countries, institutions, and authors all actively collaborated. Main recent research trends include the preference or attitude towards medical treatment in adolescents with depression; approaches for adolescents with depression to seeking medical help; and the key role of parent, family, and primary care in medical decision-making for adolescents. Thus, further attention should be paid to determining how to promote the role of parents, families, and primary care in the decision-making process and create appropriate online help-seeking tools and decision aids to facilitate shared decision-making in the future.

Are There Other Options?

This study compared University of Missouri child and adolescent telepsychiatry services patients’ specific zip codes to child and adolescent psychiatrists’ practice locations to learn if telehealth was an appropriate option for this group of patients.

In demographically and geographically diverse state such as Missouri, patients in rural areas may have limited or no access to timely, affordable and quality care. Many large urban health-care institutions have turned to telehealth as a means of providing equal access to care for all population, no matter where they choose to live.

The management analyst system Cognos/Analyzer was used as a data source. Patient- and provider-specific zip codes were processed using GeoKettle software, and ArcGIS explorer was used for map visualization.

While patients utilizing child and adolescent telepsychiatry services come from various parts of the state, providers are mostly clustered in urban locations along the Interstate 70. This greatly limits access to specialty care for rural and other vulnerable populations. Telehealth provides adequate and timely access to child and adolescent psychiatry services for the youth that may otherwise not be able to get needed care.

Barriers such as mental health crisis and access to care for rural population have been more or less successfully addressed by telehealth for several decades now. However, the shortage of specialty physicians adds an additional layer of complexity to this issue. Health-care organizations with informatics tools such as telemedicine need to focus their efforts on maximizing usage to allow more access for the underserved population.

Psychodynamic perspectives on psychotropic medications for children and adolescents

Recent trends in pediatric psychopharmacology have resulted in advances in treatment but also an overly optimistic and, at times, simplistic extension of pediatric psychopharmacology practice. Concerns about these changes in the field are discussed. The authors outline how understanding the meaning of medications to all those involved in the prescribing process can help integrate our thinking about this complex interaction with patients and their families.