New guidelines help doctors tackle teen depression

The American Academy of Pediatrics are set to release their first updated guidelines regarding teenage mental health in 10 years. They hope to catch mental health issues earlier and, therefore, intervene more successfully.

Approximately 3.1 million individuals in the United States aged 12–17 had a major depressive episode in 2016.

That equates to more than 1 in 8 adolescents. Of these, around 2.2 million experienced severe impairment during the episode.

Worryingly, only around half of adolescents with depression are diagnosed before adulthood.

To address this significant shortfall, the American Academy of Pediatrics (AAP) have recently published updates to their medical guidelines on adolescent depression.

Frontline medical staff — such as pediatricians and primary care providers — are the best placed to spot mental health changes in teenagers. But according to the AAP, "In primary care (PC), as many as 2 in 3 youth[s] with depression are not identified by their PC clinicians and fail to receive any kind of care."

A panel of experts — which includes the AAP, the Canadian Pediatric Society, and psychiatric associations from Canada and the U.S. — worked together to develop the new "Guidelines for Adolescent Depression in Primary Care." The team was steered by the latest relevant scientific evidence.

New depression guidelines

This update will be published in the March edition of the journal Pediatrics, in two parts. Part one is titled "Guidelines for adolescent depression in primary care: (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management," while part two is "Guidelines for adolescent depression in primary care: (GLAD-PC): Part II. Treatment and ongoing management."

The guidelines mark the first update in a decade and are designed to help physicians. They also provide recommendations for how both the patient and their family members can be involved in the process.

"A lot of parents go to their pediatrician for the scraped knees and sore throats but don't think of them when it comes to seeking help for emotional and behavioral issues. The American Academy of Pediatrics is supporting pediatricians so that they are prepared to identify and treat these types of issues."

Co-lead author Dr. Rachel Zuckerbrot, Fellow of the AAP

The guidelines cater for those aged 10–21. While this age range extends beyond adolescence, the authors chose this range "to include those who might be considered developmentally adolescent."

The recommendations also help healthcare providers to distinguish between mild, moderate, and severe forms of major depressive disorder.

Recommended screening for depression

For the first time, the AAP also recommend screening for depression in children aged 12 or older.

Co-lead author Dr. Amy Cheung says, "We would like to see teens fill out a depression screening tool as a routine part of their regular wellness visit. Parents should be comfortable offering any of their own observations, questions, or concerns, which will help the physician get a well-rounded picture of the patient's health."

Other recommendations in the new guidelines include:

  • Providing a treatment team including the individual, their family, and access to mental health experts.
  • Providing tools to educate and screen for depression.
  • The construction of treatment plans that cover home life, as well as school and peer interactions.
  • Creating a safe environment by, for instance, removing firearms from the home and giving the individual a way to communicate in an emergency.

There is an important focus on involving the family in decisions and treatment, but the guidelines also advise that the pediatrician spends some time alone with the individual.

Also included in the updated guidelines are situations when a physician should be more vigilant — such as for teenagers who have a family history of depression, life adversity, or previous or current substance use.

They also lay out guidelines for when a physician should consult a mental healthcare provider.

"There are often community mental health resources," says Dr. Zuckerbrot, "that families and physicians can consult to obtain the best possible care. The earlier we identify teenagers who show signs of depression, the better the outcome."

Overall, it is hoped that the guidelines will provide a quicker route to better treatment for teens in need of mental health support.