It has been over ten years since the initial publication of the American Academy of Pediatrics (AAP) endorsement of guidelines for Adolescent Depression in Primary care (GLAD-PC). The newest endorsement was released weeks after the most recent horrific school shooting trauma in Parkland, FL.
In our current society teens are at risk for depression and other mood disturbances like anxiety when exposed to traumas such as school shootings, cyber bullying, teen dating violence and even social media influences. Those are all in addition to just normal puberty hormonal changes that can also affect mood. Depression can look different in teens and can often present in the doctor’s office as somatic complaints like, “He’s been really tired.” or “She can’t remember things I tell her. It’s hard for her to concentrate.” Very seldom will an adolescent report having a problem with their mood. It is estimated that 1 in 5 adolescents will suffer from depression prior to their adult years. Although depression is treatable more than 50% of cases of adolescent depression does not get identified.
Depression is more than an occasional sad mood or defiance to the family rules.
Here are a few ways depression may present in your teen:
- Poor performances in schoolwork when previously doing well.
- No longer showing an interest in former social activities or hobbies.
- Decreased energy.
- Sleeping more or sleeping less.
- Substance use.
- Low self-esteem. Poor body image. Feelings of unworthiness.
- Isolating themselves. Withdrawing from friends and family.
- Lack of motivation.
- Irritability, aggressiveness, outbursts, agitation.
- Changes in eating habits.
- Poor concentration.
- Suicidal thoughts. Self-harming behaviors.
One of the major updates in the new guidelines includes universal yearly screenings for all children ages 12 years and older. The AAP also endorses the use of a formal depression self-reporting tool. The prior guidelines only supported systematically identifying risk factors without any universal screening.
These screenings should be implemented during: 1. well child exams, 2. for adolescents who present with chronic somatic complaints or 3. if there are risk factors for depression like a family history of depression, trauma, substance use or psychosocial stressors. There should also be a time during your teens visit that they will be interviewed alone by their pediatrician. This helps to establish a rapport and to allow your teen to freely discuss what is on their mind. However, it is also important to have the guardians insight and even more important to include the physician, teen and guardian(s) all together when establishing a safety plan.
The safety plan needs to restrict any means an adolescent might have to committing suicide, removing firearms from the home, designating a trusted adult they can speak to during a crisis. According to the CDC, depression can lead to suicide. Suicide is the second leading cause of death in children ages 10-24. The National Suicide Prevention Line is available 24/7. They provide free and confidential support and crisis resources for people and their loved ones during times of distress.
The new depression screening guidelines were updated to help primary care physicians screen for depression in adolescents in the primary care settings. It is imperative to start the screening early during this era of shortage of behavioral health resources. If your teen meets the criteria for mild depression this can be managed by your pediatrician. For moderate to severe depression, starting an anti-depressant may be required. This therapy should be managed by your pediatrician in adjunct with a mental health professional who can provide psychotherapy simultaneously.
In summary, our children deserve the best and it is important to identify signs of depression early on for the best possible outcomes.
P.S. Remember you can book an appointment with me for any pediatric non-emergent illnesses like ear aches, rashes, vomiting, pink-eye etc. or for any parenting questions about pediatric illnesses, behavior, mood or development.
All posts containing medical information are for informative purposes only and is not direct medical advice nor establishes a patient-physician relationship.
Photo by G. Madeline on Unsplash.