Version May 2024
| Evaluation |
| Consider antidepressant for patients with moderate to severe depression, or recurrent depressive episodes |
| Consider antidepressant for patients who have family members with positive response to SSRI antidepressant (and screen if family members had negative response/side effects to SSRIs) |
| Screen for potential bipolar disorder |
| Family history of bipolar disorder, pressured speech, lack of sleep, impulsivity, patient initially presents suddenly very depressed out of the blue, excessive sleeping, very slowed down |
| Review potential risk for increased agitation, suicidal ideation, and clarify importance of contacting physician if any thoughts of harm to self or others emerge |
| Review SSRI Discontinuation syndrome if medication is stopped abruptly (dizziness, paresthesias, nausea, increased irritability) |
| Have patient and family sign consent (can obtain form from www.aacap.org) |
| Follow-Up |
| If not feasible to meet weekly, ensure patient and family know how to contact physician if any thoughts of harm to self or others emerge, or if patient becomes more agitated |
| Review symptoms AND provide side effect scale (download free from www.schoolpsychiatry.org) and rating scales |
| Create reasonable expectations (time line of medication response can take four to six weeks, if taken consistently) |
| Establish realistic outcome measures with patient (medication will improve sadness, ruminations, but will not make patient "mind" better, or no longer argue about curfew/bedtime) |
| Counsel adolescent about risks of substance use, especially alcohol, when depressed and on medication |
| Consider safety issues in the home (availability of dangerous medications, weapons) and provide phone number to access emergency psychiatric services |
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