The American Academy of Pediatrics (AAP) in February published updated clinical practice guidelines to help pediatricians and other primary care providers identify and treat adolescents with depression. A notable change to the original guidelines, which were published in 2007, is the recommendation that clinicians universally screen children aged 12 and over for depression using a formal self-report screening tool during routine primary care visits.
“Research shows that only 50 percent of adolescents with depression are diagnosed before reaching adulthood,” wrote Rachel Zuckerbrot, M.D., lead author of the guidelines, and colleagues. Zuckerbrot is an associate professor of clinical psychiatry at Columbia University Medical Center and the site director of the Child and Adolescent Psychiatry for Primary Care (CAP PC) Program at Columbia University/New York State Psychiatric Institute.
“In primary care (PC), as many as 2 in 3 youth with depression are not identified by their PC clinicians and fail to receive any kind of care. Even when diagnosed by PC providers, only half of these patients are treated appropriately,” the authors wrote.
The updated guidelines, which are divided into two parts, were developed by a North American steering committee of researchers and clinical experts, with input from patients and their families.
Part I of the guidelines focuses on how primary care providers can prepare their practice settings to identify and assist youth with depression. This section includes recommendations on how to screen adolescents for depression in accordance with DSM-5 criteria, educate patients and their families about depression and treatment options, establish relevant referral and collaborations with mental health resources in the community, and implement safety plans for adolescents who may be at risk for self-harm or suicide.
Part II of the guidelines describes how primary care providers can best treat patients with depression and manage their care. Some of the topics covered in this section include when to begin treatment of depression, when to consult with mental health specialists, and how to work with mental health providers to support patient care.
“There is a growing recognition that complex chronic conditions, such as depression, are most successfully managed with proactive, multidisciplinary, patient teams,” the authors of the guidelines wrote.
“The earlier we identify teenagers who show signs of depression, the better the outcome,” Zuckerbrot stated in an AAP press release. ■
“Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management” can be accessed
here. “Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Manage-ment” is available
here.
