Sally

Sally Laden helped turn the disease of depression into a gold mine. Laden was the world’s most influential female “psychopharmacologist,” and each of her creations began with an intonation about the terrible depression epidemic sweeping the globe. In psychiatry, the depression market had proven so huge that extending it to children would be desirable. Therefore, the pediatric exclusivity provision, which provided drug makers with 6 months of patent extension in exchange for conducting trials in the pediatric population, was welcomed by industry. Four major SSRI makers struggled to get into the pediatric depression market from 2000 to 2004. GlaxoSmithKline (GSK), which made the SSRI Paxil (paroxetine), conceived several trials in pediatric depression, and Sally Laden was assigned to write up one trial, #329.

INteractive Virtual Expert-Led Skills Training: A Multi-Modal Curriculum for Medical Trainees

Background: Internationally, pediatric depression and suicide are significant issues. Additionally, in the context of the COVID-19 pandemic, pediatric mental health needs are rising astronomically. In light of Child & Adolescent Psychiatrist (CAP) subspecialist shortages in the United States (US), there is an increasing call for primary care physicians in Family Medicine and Pediatrics to address an increasingly broad variety of patient needs. Here we report on the development and preliminary evaluation of medical student and resident perceptions on the “INteractive Virtual Expert-led Skills Training” (INVEST) medical education curriculum, a virtual synchronous CAP curriculum employing active learning strategies, including expert-led discussion and video modeling, and discussion designed to meet those priorities.Methods: In a standardized 60-min training format, our curriculum leverages audience response system polling, video modeling of key clinical skills, and interactive discussion with an expert subspecialist, over a virtual video conferencing platform. The primary educational strategy relies on use of video modeling to demonstrate best practice with CAP led group discussion to solidify and explain important concepts. Five waves of medical students and residents (N = 149) participated in the INVEST curriculum and completed pre- and post-training surveys regarding knowledge and comfort in the management of pediatric patients with depression and suicidality.Results: Trainee participants reported significant positive gains in perceived likelihood of encountering pediatric suicidality as well as knowledge/comfort with depression screening and suicidality assessment in a primary care setting. Across some competency areas, there was an effect of medical learner level. Learners at lower levels generally reported the highest benefit. Medical students reported significant increases in their comfort interpreting and discussing positive depression screens and evidenced the greatest relative benefit in comfort with discussing suicidality.Conclusion: To our knowledge, INVEST is the first fully virtual, multimodal curriculum led by expert CAP subspecialists. Our findings suggest that INVEST shows promise for equipping medical learners with baseline knowledge for caring for patients with pediatric depression and suicidality. This synchronous, virtually delivered curriculum allows for critical training delivered to diverse medical learners regardless of geographic location, a particular benefit during the current COVID-19 pandemic.

Several weeks of low mood, decreased appetite, and poor sleep after changing schools

Major depressive disorder (MDD) is one of the most common psychiatric disorders affecting children and adolescents. The diagnostic criteria require the history of one or more depressive episodes in the absence of a history of mania. In contrast to adults, youth may experience predominantly irritable rather than sad mood. The assessment of depression should include a psychiatric evaluation, medical history, and focused laboratory studies to rule out medical and/or substance-related causes. The evaluation should also consider potential precipitants such as recent losses, interpersonal problems, or trauma. The patient should be asked directly about suicidal ideation, plans, and past attempts. Psychotherapy alone or in combination with antidepressant therapy is effective for the treatment of pediatric depression. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are the most well-studied psychotherapies. Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication class and should be considered in moderate to severe cases of depression.

Choline in Pediatric Depression

Purpose of Study: The prefrontal cortex has been previously implicated in the neuropathology of major depressive disorder (MDD). Hence, we used proton magnetic resonance spectroscopy (1H-MRS) to examine choline levels in the prefrontal cortex of youth with major depression. Basic Procedures: Twelve age- and sex-matched case-control pairs were examined (age range 10 to 18 years, 7 females and 5 males in each group). All subjects were treatment naive at the time of the scan. A long echo 1H-MRS scan was acquired from the right prefrontal cortex (4cc) in all subjects. Main Findings: Right prefrontal Choline/Creatine ratios were elevated in the youth with mood disorders (F1, 11 = 10.741, p = 0.007) as compared with healthy controls. Principal Conclusions: These findings suggest that prefrontal cytosolic choline may be increased in youth with MDD in comparison with healthy controls. This is consistent with reported findings in both adults and adolescents and suggests that MDD in youth is associated with alterations in choline metabolism in the prefrontal cortex.