For a plethora of reasons, most of which are unknown, adolescents and children as young as 10 are suffering from depression and suicidality at a rate higher than ever before. Speculation points to environmental stressors such as social media, bullying and cyberbullying, lack of sleep, family dissolution, lack of attachment and bonding, increased exposure to trauma including social and familial wounding, violent media exposure, abuse, and early initiation to psychoactive drugs and sexual debut. Predisposition for depression is a heritable trait that in times past may never have been exposed or provoked by the stressors kids today are facing during their preteen and early adolescence.
To address this growing problem, Cheung AH, Zuckerbrot RA, et al, set out to create new clinical practice guidelines to assist primary care physicians (PCP) in screening and assessing depression in the target population. The second part of the updated guidelines addressed treatment modalities and ongoing management of adolescent depression in the primary care setting. The recommendations included:
- Active monitoring of mildly depressed youth
- Treatment with evidence-based medication and psychotherapeutic approaches in cases of moderate and/or severe depression
- Close monitoring of side effects
- Consultation and co-management of care with mental health specialists
- Ongoing tracking of outcomes
- Specific steps to be taken in instances of partial or no improvement after an initial treatment has begun
The new clinical guidelines for adolescent depression in the primary care setting will not replace sound clinical judgment by experienced doctors and are not intended to be the sole source of guidance for assessment and managing depression among children and adolescents. However, the environment and culture in which children maturate is changing rapidly and not for the better. So, any evidence or consensus based guidelines must be dynamic and regularly updated by more research and the best available evidence. Further, PCPs can no longer simply refer to child psychiatry as there is a serious shortage of qualified doctors to meet the public need. Overall, there is a great clinical need and a dearth of mental health specialists. Additional research concerning the management of depressed youth by PCP is desperately needed if we hope to improve the abysmal outcomes and rising mortality of depressed youth.
Cheung AH, Zuckerbrot RA, et al. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management. Pediatrics, 2018 Feb 26. pii: e20174082. doi: 10.1542/peds.2017-4082. [Epub ahead of print]