Managing Depression in Adolescents

Part 1: Differential

This post will be a bit of a longer series. Rather than one extremely long (& potentially boring) post we will break this up into several. To begin, let’s discuss the differential diagnoses for depression. But, before digging into that, let’s zoom out & define the term: Differential Diagnosis.

A differential diagnosis is the process of identifying which condition or disease a patient might have, based on their presentation, namely their reported symptoms and outward signs. When running through a differential diagnosis, you should be thinking of a list of possible diagnoses, each of which may explain the patient’s presentation. Understanding details of various conditions will not only help to filter possible diagnoses from more likely to less likely, but also help to guide the assessment from start to finish. An accurate differential diagnoses is a crucial step in the diagnostic process and it will help to guide treatment planning. In some instances the most likely diagnosis is obvious, other times, it is more difficult to arrive at a final diagnosis.

When working with adolescents this process remains essential, especially as there are a number of childhood d/o that share many signs and symptoms.

With that said, let’s dig into it.

DIFFERENTIAL:

For the purposes of this text (as well as general accuracy) depression ≠ MDD. Depression is a symptom and MDD is a diagnosis.

Depression is a complex mental health condition that can be caused by a variety of factors. For example, individuals may experience depression as a result of co-occurring psychiatric disorders such as anxiety, dysthymia, attention-deficit/hyperactivity disorder, or substance abuse. Additionally, medical conditions such as hypothyroidism, mononucleosis, anemia, certain cancers, autoimmune diseases, premenstrual dysphoric disorder, and chronic fatigue syndrome can also contribute to the development of depression. Furthermore, life events such as bereavement or depressive reactions to stressors can also lead to the onset of depression. It is important to note that these conditions may cause symptoms similar to depression, but should not be diagnosed as major depressive disorder (MDD) or dysthymic disorder (DD) unless they meet the criteria for these disorders.

Another important consideration in the diagnosis of depression is the potential for medication-induced symptoms. For example, certain medications such as stimulants, corticosteroids, and contraceptives may cause symptoms similar to depression. Therefore, it is crucial to evaluate whether an individual's depressive symptoms are solely due to the illnesses or medications before making a diagnosis of MDD or DD.

In children and adolescents, the differential diagnosis of depression is further complicated by the potential for bipolar disorder. Many children and adolescents presenting for treatment are experiencing their first episode of depression, making it difficult to differentiate between unipolar major depression and the depressive phase of bipolar disorder. Indicators such as high family loading for bipolar disorder, psychosis, and history of pharmacologically induced mania or hypomania may herald the development of bipolar disorder. Furthermore, it is important to evaluate carefully for the presence of subtle or short-duration hypomanic symptoms as these symptoms are often overlooked, and these children and adolescents may be more likely to become manic when treated with antidepressant medications. However, it's important to note that not all children who become activated or hypomanic while receiving antidepressants have bipolar disorder.

DISCLAIMER

This is not Medical Advice and while the reader believes what he has shared, substack dot com does not equate to strong evidence. Please do not treat patients based on what is read in this post, these are opinions of an internet stranger. Instead use these posts as a starting point for furthering your own study & education.