PsychEd Episode 58: Depression in Children and Adolescents with Dr. Darren Courtney

PsychEd: educational psychiatry podcast

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers depression in children and adolescents with Dr. Darren Courtney, a scientist with the Cundill Centre for Child and Youth Depression and the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health and a staff psychiatrist in the Youth Addictions and Concurrent Disorders Service at the Centre for Addiction and Mental Health (CAMH) in Toronto. He is also an associate professor in the Department of Psychiatry at the University of Toronto.

Dr. Courtney earned his MD in 2004 at Queen’s University and completed psychiatry residency in 2009 at the University of Ottawa. He was the clinical director of the Youth Inpatient Unit at the Royal Ottawa Mental Health Centre from 2009 to 2014 and moved to Toronto in 2014, where he worked on the Concurrent Youth Inpatient Unit at the Centre for Addiction and Mental Health until 2017 and where his clinical work with concurrent disorders continues now with outpatient youth.

Dr. Courtney's research focus is on the treatment of adolescent depression through the use of an integrated care pathway — a collaboratively developed treatment algorithm based on high-quality clinical practice guidelines. Through his research, he works on identifying quality practice guidelines and corresponding multi-disciplinary care pathways to facilitate evidence-based and measurement-based care for adolescents with depression. He has also participated in a systematic review and quality appraisal of clinical practice guidelines for psychiatric disorders in children and adolescents. Additionally, he has an interest in the management of concurrent disorders, where young people are affected by both primary psychiatric disorders and substance use disorders.

The learning objectives for this episode are as follows:

By the end of this episode, you should be able to…

1. Outline the prevalence and risk factors for depression in children and adolescents

2. Explain how children and adolescents with depression present in clinical practice

3. Discuss the use of screening tools for depression in this population

4. Describe an approach to the management of depression in children and adolescents

5. Outline the management of an adolescent with suicidal thoughts or behaviours

Guest: Dr. Darren Courtney

Hosts: Kate Braithwaite (MD) and Nikhita Singhal (PGY5)

Audio editing by: Nikhita Singhal

Show notes by: Kate Braithwaite and Nikhita Singhal

Interview Content:

• Introduction - 0:00

• Learning objectives - 02:11

• Prevalence of depression in youth - 03:11

• Risk factors for depression in youth - 06:25

• Diagnosing depression in youth - 08:30

• Screening tools - 14:24

• Approach to taking a history from youth - 19:45

• Management of depression in youth - 30:12

• Psychotherapies - 33:20

• Medications - 37:37

• Assessing and managing suicidality in youth - 44:00

• Measurement based care - 51:00

• Final thoughts - 55:10

Resources:

• Previous PsychEd episodes:

• PsychEd Episode 1: Diagnosis of Depression with Dr. Ilana Shawn

• PsychEd Episode 2: Treatment of Depression with Dr. Sidney Kennedy

• PsychEd Episode 18: Assessing Suicide Risk with Dr. Juveria Zaheer

• ICHOM Set of Patient-Centered Outcome Measures for Children & Young People with Depression & Anxiety

• Screening tools/rating scales:

• Revised Children's Anxiety and Depression Scale (RCADS)

• Mood and Feelings Questionnaire (MFQ)

• NICE guideline: Depression in children and young people: identification and management

• NICE guideline: Self-harm: assessment, management and preventing recurrence

• The CARIBOU Pathway by CAMH: A youth-centered program for the treatment of depression

• Includes links to download free clinician-specific and youth-specific resources co-developed with youth and mental health clinicians

• Clinical Innovations and Tools | Cundill Centre for Child and Youth Depression | CAMH

• Includes links to various tools for health care providers, researchers, youth, and other stakeholders (such as teachers and family members) informed by research evidence

References:

• Bennett K, Courtney D, Duda S, Henderson J, Szatmari P. An appraisal of the trustworthiness of practice guidelines for depression and anxiety in children and youth. Depress Anxiety. 2018 Jun;35(6):530-540. https://doi.org/10.1002/da.22752

• Courtney D, Bennett K, Henderson J, Darnay K, Battaglia M, Strauss J, Watson P, Szatmari P. A Way through the woods: Development of an integrated care pathway for adolescents with depression. Early Interv Psychiatry. 2020 Aug;14(4):486-494. https://doi.org/10.1111/eip.12918

• Georgiades K, Duncan L, Wang L, Comeau J, Boyle MH; 2014 Ontario Child Health Study Team. Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study. Can J Psychiatry. 2019 Apr;64(4):246-255. https://doi.org/10.1177%2F0706743719830024

• Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Health Technol Assess. 2017 Mar;21(12):1-94. https://doi.org/10.3310/hta21120

• Hetrick SE, McKenzie JE, Bailey AP, Sharma V, Moller CI, Badcock PB, Cox GR, Merry SN, Meader N. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021 May 24;5(5):CD013674. https://doi.org/10.1002/14651858.CD013674.pub2

• MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJ, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Can J Psychiatry. 2016 Sep;61(9):588-603. https://doi.org/10.1177%2F0706743716659276

• National Institute for Health and Care Excellence. Depression in children and young people: Identification and management NG134 [Internet]. London: NICE; 2019 Jun 25 [cited 2023 Sep 22]. Available from: https://www.nice.org.uk/guidance/ng134.

• Parikh A, Fristad MA, Axelson D, Krishna R. Evidence Base for Measurement-Based Care in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am. 2020 Oct;29(4):587-599. https://doi.org/10.1016/j.chc.2020.06.001

• Walter HJ, Abright AR, Bukstein OG, Diamond J, Keable H, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry. 2023 May;62(5):479-502. https://doi.org/10.1016/j.jaac.2022.10.001

• Wiens K, Bhattarai A, Pedram P, Dores A, Williams J, Bulloch A, Patten S. A growing need for youth mental health services in Canada: examining trends in youth mental health from 2011 to 2018. Epidemiol Psychiatr Sci. 2020 Apr 17;29:e115. https://doi.org/10.1017%2FS2045796020000281

• World Health Organization. Mental health of adolescents [Internet]. 2021 [cited 2023 Sep 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

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