Studies have revealed that up to 9% of teenagers meet criteria for depression at any one time, with as many as 1 in 5 teenagers having a history of depression at some point during adolescence. In primary care (PC) settings, point prevalence rates are likely higher, with rates up to 28%. American Academy of Pediatrics has released Guidelines for Adolescent Depression in Primary Care (GLAD-PC) which new guidance for primary care clinicians to aid in diagnosing and managing depression in children and adolescents aged 10 to 21. Dr.Rachel A. Zuckerbrot, M.D., from the Columbia University Medical Center in New York City, and colleagues updated guidelines which have been published in Paediatrics.
According to the Centers for Disease Control and Prevention depression leading to suicide is the second-leading cause of death for children aged 10 to 24.These guidelines will help primary care doctors who may be in a position to help teenagers showing signs of depression in their practice settings.
Major recommendations :
Screening and Treatment
- Universal depression screening is recommended annually for adolescents aged 12 and older. This recommendation is in line with that of the U.S. Preventive Services Task Force. There was not enough evidence to recommend one screening tool over another.
- Initial management should include a safety plan, including limiting access to lethal medication and weapons, enlisting a third party, and establishing an emergency communication plan.
- For mild depression, clinicians can consider active support and monitoring for 6 to 8 weeks prior to treatment.
- For adolescents with moderate-to-severe depression or complicating, factors like substance abuse, primary care clinicians should consider consulting with a mental health specialist.
- When appropriate, clinicians should recommend psychotherapies like cognitive behavioural therapy or interpersonal psychotherapy for adolescents and/or antidepressants like selective serotonin reuptake inhibitors.
- PC clinicians should monitor for the emergence of adverse events during antidepressant treatment (SSRIs)
The AAP has urged parents with depressed teens to keep away from firearms as adolescent suicide risk is strongly associated with firearm availability.
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