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 "From a parent's perspective, I think it’s important for them to
know that depression can be relatively common in adolescence and we
have ways to treat it," said Dr. Alex Krist, a member of the U.S.
Preventive Services Task Force (USPSTF) and professor at Virginia
Commonwealth University in Richmond.
The USPSTF says about 8 percent of U.S. adolescents experience major
depression each year. Less is known about how common the condition
is among younger children, however.
Children and adolescents with depression typically have problems at
school, work and home. Being depressed early in life is also linked
to increased risks - of the condition recurring in adulthood, of
suicide and of other mental disorders.
Previously, the USPSTF recommended screening for depression among
kids ages 12 to 18 years if their doctor's office had systems in
place for accurate diagnosis, psychotherapy and follow-up care.
To update its recommendation, the panel commissioned researchers at
RTI International in Research Triangle Park, North Carolina, and at
the University of North Carolina at Chapel Hill to review existing
research up to February 2015.
The review found no direct evidence of harms in screening
adolescents for depression. They researchers also found evidence
supporting the effectiveness of two particular screening tools when
used for adolescents. The Patient Health Questionnaire for
Adolescents and the Beck Depression Inventory are both
questionnaires that teens can answer on their own.
"If they score high on those instruments, the next step would be to
make a formal diagnosis," Krist said.
The final USPSTF report also states there are several ways to treat
depression in adolescents, including medications and psychotherapy.
The authors acknowledge there are some risks in treating adolescents
with medications, such as selective serotonin reuptake inhibitors (SSRIs),
but those potential harms are small when patients are closely
monitored. Known side effects of SSRIs include weight gain, nausea,
dizziness, insomnia, agitation or restlessness and headaches.
"I think what we want clinicians to hear is that there is pretty
good evidence that routine screening in adolescents for depression
and making sure they get the appropriate follow-up improves
outcomes," Krist said.
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In an editorial accompanying the new recommendation, Dr. John W.
Williams, Jr. of the Durham VA Medical Center in North Carolina and
Dr. Gary Maslow of Duke University, also in Durham, said improving
the recognition and treatment of depression in primary care would
have an enormous benefit.
Dr. O’Nisha Lawrence, a psychiatrist at The Children's Hospital of
Philadelphia who wasn't involved in the new recommendation, said
it's great that pediatricians will be checking for depression,
because children with the condition will likely first see a
pediatrician.
"Treating someone early on can change the trajectory of what happens
later," said Rhonda Boyd, a psychologist at the Children's Hospital
of Philadelphia who also wasn't involved in the new recommendation.
She said those treated early will likely have less severe bouts of
depression and a less chronic course going forward.
Just as it had in 2009, the USPSTF concludes there is not enough
evidence to recommend depression screening for children younger than
age 12, but parents and doctors should still be vigilant for
depression symptoms among those kids, Krist said.
"Hopefully with these recommendations, more people will be doing
more research on how to best screen for depression in the younger
children," Lawrence said.
SOURCE: http://bit.ly/SQRXAa Annals of Internal Medicine, online
February 8, 2016.
(Corrects paragraph 14 to reflect that early treatment is likely to
lead to a less chronic course of depression - not more chronic.)
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