Depression - Paediatric Palliative Care
Description General and supportive treatment Medicine and treatment ICD-10 code: F32-34 DESCRIPTION Low mood in children and adolescents who become aware of their impending death is often congruent and appropriate and does not always warrant treatment. However, around 10 to 30% of chronically ill children are depressed. DSM 5 criteria instruct clinicians to exclude “symptoms that are c
General and supportive treatment
ICD-10 code: F32-34
DESCRIPTION
Low mood in children and adolescents who become aware of their impending death is often congruent and appropriate and does not always warrant treatment. However, around 10 to 30% of chronically ill children are depressed. DSM 5 criteria instruct clinicians to exclude “symptoms that are clearly due to a general medical condition” BUT this may lead to an under diagnosis of depression in this population.
GENERAL AND SUPPORTIVE TREATMENT
- Exclude and treat unaddressed pain.
- Communicate openly about diagnosis and prognosis.
- Address commonly occurring non-illness stressors (educational, familial, social and financial).
- Provide supportive counselling: opportunities for open communication about fears and worries.
- Cognitive behavioural therapy plus peer group support.
- Provide creative outlets: music, art and writing.
- Legacy work (memory making) in children nearing end of life.
MEDICATION AND TREATMENT
- Mild or congruent depression does not always need to be medicated and is best addressed with non-pharmacological measures as above.
- Moderate to severe depression may need to be treated. Medication should never be prescribed alone without counselling interventions. S
- SRIs are generally the mainstay of treatment of depression in this population.
See: Depression in childhood and adolescence.
Although fluoxetine is usually first-line treatment for depression in children without other medical illnesses, citalopram may be safer in palliative care patients as it has fewer interactions (esp. involving cytochrome p450 enzyme) with other drugs (including chemotherapy). Citalopram also has the added benefit of being helpful if there is co-existent anxiety. Note that it takes 4 to 6 weeks for SSRIs to achieve therapeutic effect.
- Citalopram, oral, 0.4 mg/kg/day.
- Dose range: 5–40 mg daily.
- Recommended average dose: 10–20 mg/day.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.1 Symptom Control, 21.1.3 Neuropsychiatric Symptoms, 21.1.3.2 Depression