Younger children are more likely to have somatic symptoms, restlessness, separation anxiety, phobias, and hallucinations.26 The child's cognitive level should be considered; for example, younger children may appear sad but have difficulty verbalizing their mood.27 Differences have been found between parent reports and self-reports of depressive symptoms. All Rights Reserved. We give them the tools they need to become successful young adults. Mayo Clinic does not endorse companies or products. Medical conditions that may present similarly to depression include hypothyroidism, anemia, autoimmune disease, and vitamin deficiency. Frontiers in Psychiatry. Search dates: March 5 and 11, 2011. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Additionally, a safety plan should be established that limits access to lethal means, such as removing firearms from the home or locking them up. https://www.nimh.nih.gov/health/publications/teen-depression/. The overall prevalence of depression in adolescents is around 6% and that . Published April 23, 2022 Updated April 27, 2022 Leer en espaol Health risks in adolescence are undergoing a major shift. 2019;173(3):300. doi:10.1001/jamapediatrics.2018.5017, 2023 American Medical Association. Those who were reassessed at four weeks improved the most at 16 weeks (a difference of 5.7 points on the Hamilton Rating Scale for Depression; scores on this scale can range from 0 to 58 points, with a score of 0 to 7 considered normal and a score of 20 associated with moderate depression; P < .05). Allergan Inc.; 2020. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=13bb8267-1cab-43e5-acae-55a4d957630a&audience=consumer. Referral to a licensed mental health professional is appropriate at any point in the treatment process. Accessed June 29, 2021. Preventing anxiety Over the past decade, some of the most promising research around the causes and development of anxiety disorders has been led by developmental psychologists. Frequency of contact with doctors or mental health professionals depends on your child's needs. Evidence is mixed for the use of CBT as monotherapy in children and adolescents with depression. However, further inquiry into patient symptoms may be required because some tools lack specificity or are prone to oversensitivity. Other psychological conditions that may present similarly to major depressive disorder include persistent depressive disorder (also called dysthymia) and disruptive mood dysregulation disorder. https://www.aafp.org/afp/2018/1015/p508.html#afp20181015p508-t6, https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/index.shtml#outpatient, Recommendation from evidence-based guidelines, Evidence from response in placebo arms of trials and recommendation from consensus guidelines, Consistent evidence from several randomized trials, Evidence from several randomized trials and systematic reviews. It is important to rule out bipolar disorder when diagnosing depression, because antidepressant medications can initiate manic symptoms. Exercise and spirituality may also be incorporated into the treatment of adolescents with depression because they improve symptoms with no known harms.1. See permissionsforcopyrightquestions and/or permission requests. Depression in Teens It's not unusual for young people to experience "the blues" or feel "down in the dumps" occasionally. Consider contacting a local mental health advocacy parent group such as the National Alliance on Mental Illness. Author disclosure: No relevant financial affiliations. This content does not have an Arabic version. Cognitive behavioral therapy and another therapy, interpersonal therapy, have the most evidence for treating adolescent depression. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. other information we have about you. If the diagnosis is confirmed, treatment should be initiated for persistent, moderate, and severe depression. Fluoxetine and escitalopram are the only antidepressants approved by the U.S. Food and Drug Administration for treatment of depression in children and adolescents. Teen Depression: The Pros and Cons of Medication - PsyCom Whereas CBT focuses on cognition and behaviors, interpersonal psychotherapy concentrates on improving interpersonal relationships and typically includes around 12 to 16 sessions. The use of screening tools in children with at least one risk factor may be more helpful than universal screening. Conflict of Interest Disclosures: None reported. The U.S. Preventive Services Task Force (USPSTF) recommends screening children and adolescents 12 to 18 years of age for major depressive disorder with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. Treatment must take into account the severity of depression, suicidality, developmental stage, and environmental and social factors. One normal reaction is to feel overwhelmed and not know what to do. The cognitive component of the treatment focuses on helping . A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based on the review. information and will only use or disclose that information as set forth in our notice of 1 The incidence of depression among children and . Search dates: November 2018 to January 2019, and September 27, 2019. Not all therapy is the same. Data sources Twelve electronic databases were searched for eligible studies published from inception to 1 January 2022. Dwyer JB, et al. There could be a variety of potential reasons for an increased risk. Risk factors include a family history of depression, parental conflict, poor peer relationships, deficits in coping skills, and negative thinking. The antidepressant imipramine is approved by the FDA to treat daytime or nighttime involuntary urination (childhood enuresis) in children 6 years of age and older. If a child or adolescent does not improve after initial treatment for depression, the primary care physician may add, change, or increase a medication and may consider referral for psychotherapy. Anafranil (prescribing information). There is no symptom improvement with serotonin-norepinephrine reuptake inhibitors compared with placebo in adolescents with major depressive disorder. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) Has the patient been treated for depression with medication in the past? Accessed May 15, 2021. This content is owned by the AAFP. JAMA Pediatr. Although good evidence regarding the duration of medication treatment in adolescents with depression is lacking, the GLAD-PC guidelines recommend continuing medication for one year beyond the resolution of symptoms.50. One trial found that early reassessment of depression is valuable.43 In this study, all youth received interpersonal psychotherapy and were randomized to a four- or eight-week follow-up assessment for treatment modification. Young people's mental health is finally getting the - Nature Depression Guideline Depression Treatments for Children and Adolescents APA's Clinical Practice Guideline recommends two psychotherapy interventions as well as a selective-serotonin reuptake inhibitor (SSRI) for the treatment of depression in adolescents. Design Umbrella review. This series is coordinated by Joanna Drowos, DO, MPH, MBA, contributing editor. 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Accessed May 15, 2021. Recommended initial dose and maximum dose vary by age. Antidepressants come with a medication guide that advises parents and caregivers about risks and precautions. Psychological Treatments for Depression in Adolescents. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, 2019;173(3):300. doi:10.1001/jamapediatrics.2018.5017. A total PHQ-9 score of 10 points or more has a good sensitivity and specificity for major depressive disorder. Medical illness (e.g., asthma, diabetes mellitus, migraines), Other psychological disorders (e.g., anxiety, learning disorders), Negative thinking styles (e.g., Things like this always happen to me, Nothing will ever go as planned), Loss of relationship (e.g., death of family member or friend, romantic relationship, friendship), Traumatic event (e.g., physical or sexual abuse, accident), Center for Epidemiological Studies Depression Scale, Center for Epidemiological Studies Depression Scale for Children, A. Accessed May 15, 2021. American Academy of Child and Adolescent Psychiatry. Antidepressants in children and adolescents: Meta-review of efficacy, tolerability and suicidality in acute treatment. Diagnostic criteria are the same for children and adults, with the exception that children and adolescents may express irritability rather than sad or depressed mood, and weight loss may be viewed in terms of failure to reach appropriate weight milestones. Zoloft (prescribing information). Copyright 2023 American Academy of Family Physicians. Eli Lilly and Company; 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6b28c424-0b7e-4b75-b090-f116b113554e. If we combine this information with your protected Accessed May 15, 2021. Approximately 60 percent of adolescents with depression have recurrences throughout adulthood.2 Furthermore, adults with a history of adolescent depression have a higher rate of suicide than those without such a history.2 Adolescent-onset depression has been associated with abuse and neglect3; poor academic performance; substance use; early pregnancy; and disruptions in social, employment, and family settings into adulthood.46 Although the prevalence of adolescent depression is high, it is significantly underdiagnosed and undertreated.7 Because of the lack of mental health care professionals, family physicians are often responsible for detecting and treating childhood and adolescent depression.810, Although risk factors for childhood and adolescent depression can be categorized as biologic, psychologic, or environmental (Table 1), these factors are often intertwined.7,8,11,12 For example, parental depression is strongly associated with childhood and adolescent depression; children of parents with depression have a threefold greater risk of developing depression than those whose parents have no such history.13,14 Furthermore, the age when risk factors occur may predict future depression. Screening tools include the Beck Depression Inventory for Primary Care for adolescents 12 to 18 years of age, and the Children's Depression Inventory for children and adolescents seven to 17 years of age.16,17 The Beck Depression Inventory for Primary Care is a self-report tool that includes seven questions that are scored from zero to three points each (Figure 1).17,18 A score of at least 4 warrants further evaluation for depression.19 The Children's Depression Inventory is available in self-report, parent-report, and teacher-report versions; scores are converted to a T-score, with scores of 65 or more indicating clinical significance.20 Additional screening tools are described in Table 2.2124 Screening tools should be selected based on patient's age, reading level, and time available to complete the measures. Kaminski JA, et al. However, not all mental health researchers believe these warnings are necessary. How to Help a Teen With Depression: 9 Pieces of Advice - Healthline the unsubscribe link in the e-mail. A study published in Psychotherapy and Psychosomatics found cognitive behavioral therapy to be effective, in treating binge eating disorder in adolescence, with lasting results.. Binge-eating . Cognitive behavior therapy and interpersonal therapy should be used for the treatment of mild depression. To provide you with the most relevant and helpful information, and understand which The U.S. Preventive Services Task Force concluded that screening adolescents 12 to 18 years of age may lead to earlier detection and treatment of depression.15 There was insufficient evidence to recommended routine screening for younger children in primary care settings. Suicidality in children and adolescents being treated with antidepressant medications. Add up the numbers endorsed for questions 1 to 9 and obtain a total score. Most children who take antidepressants for depression will improve with medication. What Is The Most Effective Way To Treat Adolescent Depression? Children and adolescents with moderate or severe depression or persistent mild depression should be treated with fluoxetine (Prozac) or escitalopram (Lexapro) in conjunction with cognitive behavior therapy or other talk therapy. Review/update the The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. Cognitive behavior therapy (CBT) and interpersonal therapy have been proven effective in the treatment of adolescent depression, and CBT has been proven effective in the treatment of childhood depression. The functional impairment question (How difficult) needs to be rated at least as somewhat difficult.. Cognitive behavior therapies are effective in treating adolescent depression. If you have questions about your own mental health, start with seeing your own primary care clinician and consider if you could also benefit from help. However, combining medication with talk therapy (psychotherapy) is likely to be even more effective. The prevalence of major unipolar depression in children and adolescents is increasing in the United States. Still, the FDA considered the findings concerning enough to issue a public health advisory and require manufacturers to label antidepressants with strong warnings about the link to suicidal thinking and behavior in children, teenagers and young adults under 25. 2023 American Medical Association. We strive to counsel our residents on overcoming addictions, negative behaviors, and poor decision-making. Dysthymic disorder in children and adolescents is characterized by depressed mood on most days for one year. Helping an adolescent who has depression can be a slow and sometimes frustrating process. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. The highest risk of suicidal thinking and behavior occurs: Parents and caregivers should closely observe the child on a daily basis during these transition periods and watch for worrisome changes for the whole time the child takes antidepressants. Effectiveness of physical activity interventions for improving Some adolescents may benefit from an antidepressant, such as a selective serotonin reuptake inhibitor. For mild depression, which may be short-lived, primary care physicians should consider active support such as counseling about depression and treatment options, facilitating caregiver/patient depression self-management, and monitoring the patient every week or two for six to eight weeks before initiating pharmacotherapy and/or psychotherapy. Treatment duration for talk therapy in adolescents with unipolar depression is typically six months or less, but longer treatment may be necessary. Therefore, a thorough assessment is needed, with possible mental health consultation or referral. This is a tough problem for adolescents whose bodies want to go to sleep later but have to wake up earlier because of school. The therapist works with parents to learn or improve skills to manage their child's behavior. One review reporting the impact of treatment of adolescent mental health disorders in primary care settings suggests some preliminary evidence that treatments by specialist staff working in primary care were effective, although quality of included studies was variable . However, the warning should be taken as a caution to carefully weigh the pros and cons of using antidepressants in children and teenagers against the real risk of suicide as a result of untreated depression. B. idealism Vande Voort JL (expert opinion). Evidence for the Management of Adolescent Depression - PMC Tricyclic antidepressants, other selective serotonin reuptake inhibitors, and serotonin-norepinephrine reupta ke inhibitors have not been shown to be effective in treating depression in children and adolescents.46,5254 If neither fluoxetine nor escitalopram is effective and antidepressant therapy is desired, referral to a child or adolescent psychiatrist is recommended. Sleep is very important, as not getting enough sleep has been associated with worsening depression. 4. Data Sources: We conducted general and targeted searches using Essential Evidence Plus, Ovid Medline, PubMed, the Cochrane Database of Systematic Reviews, the U.S. Preventive Services Task Force, the Agency for Healthcare Research and Quality, and UpToDate, including the key words children or adolescents with depression. All Rights Reserved. All rights reserved. For mild depression, which may be short-lived, primary care physicians should consider active support such as counseling about depression and treatment options, facilitating caregiver/patient depression self-management, and monitoring the patient every week or two for six to eight weeks before initiating pharmacotherapy and/or psychotherapy.4650 According to the DSM-5, although the symptoms of mild depression are distressing, they are manageable and result in only minor impairment in functioning, whereas severe depression causes more seriously distressing, unmanageable symptoms that greatly impact functioning.
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