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Depression hos barn och unga

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Sakkunnig:

Definition:
Depression hos barn och unga.
Förekomst:
14–25 % av alla ungdomar upplever minst en episod med depression.
Symtom:
Sänkt stämningsläge, nedsatt förmåga till lust och glädje, förändrad självkänsla, och aktivitetsnivå, ofta associerade med somatiska symtom.
Kliniska fynd:
Nedstämdhet, passivitet eller irritabilitet, negativa tankar om sig själv samt dödstankar.
Diagnostik:
Diagnostiken vilar helt på en klinisk bedömning. Avgränsat insjuknande eller försämring där kärnsymtomen med irritation, nedstämdhet eller glädjelöshet framträder tydligt. Upprepade episoder och stöd av ärftlighet stöder diagnosen. Självskattningsformulär kan användas för att värdera förloppet men inte för diagnostik.
Behandling:
Multimodal och individuellt anpassad behandling. Huvudsaklig behandling är psykoterapi, eventuellt med antidepressivt läkemedel (fluoxetin). Det är lämpligt att först starta med psykopedagogiskt stöd i samråd med ungdom och föräldrar med syfte att återta rutiner med mat, sömn och vardag, anpassa skolgången så att den stöder men inte belastar med krav, minska konfliktnivån och successivt öka på med aktiviteter. 
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  • Håkan Jarbin, med dr och överläkare, BUP, Länssjukhuset Halmstad
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet