US panel reaffirms depression screening for adolescents

Adolescents between 12 and 18 years old in the U.S. should be screened for depression, according to guidelines reaffirmed by a government-backed panel of prevention experts.

"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.

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 more 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.