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09/02/2016

Allteensshouldbescreenedfordepression,taskforcerecommendsCNN.com

All teens should be screened for depression, task


force recommends
By Carina Storrs, Special to CNN
Updated 2228 GMT (0628 HKT) February 8, 2016

Home
All primary care doctors should screen adolescents routinely for depression, new recommendations said.

Story highlights
Primary care doctors should screen young
people ages 12 to 18 for depression
Doctors should have a system in place for
connecting adolescents to care for depression
There is not evidence to recommend routine
depression screening of children younger than
12

(CNN)All primary care doctors, including


pediatricians and family physicians, should screen
adolescents routinely for depression, new
recommendations of the U.S. Preventive Services Task
Force said, and those doctors should have a system in
place to connect young people to treatment for
depression if they need it.
The group decided that there was good evidence to
support screening for all young people between the
ages of 12 and 18. For children younger than 12, there
is not enough evidence around which tests work and
which treatments are effective to recommend that
doctors screen all individuals in this age group.

The new recommendations for screening adolescents


"very much parallel the recommendations for adults (18 and older)," said Dr. Alex H. Krist, associate
professor of family medicine at Virginia Commonwealth University and member of the Task Force that wrote
the recommendations, which came out on Monday in the Annals of Internal Medicine.
The last iteration of the recommendations for both adolescents and adults, in 2009, stated that doctors
should only screen for depression if systems were in place to help at-risk individuals get appropriate
treatment and followup care. That is no longer enough. Doctors should put those systems in place, if they
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09/02/2016

Allteensshouldbescreenedfordepression,taskforcerecommendsCNN.com

haven't already, and screen everyone.


"We believe that health care has advanced a lot and it's more the norm to have systems in place," Krist said.
The Task Force did not outline the types of systems
that primary care doctors could create, but there is a
range of possibilities, such as having mental health
providers in the primary care practice or referring atrisk patients to therapists at other clinics or in the
community, Krist said. Some experts think the best
situation for patients is to have mental health
providers in the clinic so they can go directly to them
for a diagnosis and to discuss treatment options.

Related Article: Calming the teenage mind


in the classroom

"The front line of adolescent mental health is in the


pediatric and family care practice," said Dr. Gary
Maslow, an assistant professor of pediatrics and
psychiatry and behavioral sciences at Duke
University, who co-authored an editorial about the
new recommendations. The guidelines reiterate how
important it is for primary care doctors to screen

adolescents, he said.
Screening adolescents is not difficult, Maslow said. "I don't think it's that much more complex than the
things [doctors] are already doing."
But the payoff is big. "The biggest challenge is identifying adolescents." They might look fine but "without
screening they fall thru the cracks and don't come to attention until the symptoms get worse," Maslow said.
"I think we have medications and therapies that are effective."

Antidepressants are OK for adolescents


The recommendations specified two types of questionnaires for doctors to use to screen adolescents. One
of them, the PHQ-A, is a version of the nine-question test for adults called the Patient Health Questionnaire,
modified for adolescents. The other is based on a 21-question survey that asks about symptoms of
depression.
The Task Force did not provide guidance on how
often doctors should screen adolescents because
"there are not as much data about what the best
interval is," Krist said. "In my practice, we aim to
check adolescents and adults every year, commonly
during a wellness exam."

Related Article: Suicide rates among


young black boys on the rise

Another change in the current recommendations is to


support the use of antidepressant medication for
treating adolescents who have depression. "In 2009
the evidence of benefits was around therapy ... so we
were advocating therapy. Now we are saying it can
be medication, therapy or a combination," Krist said.
A common therapy for this age group is cognitive
behavioral therapy, which focuses on modifying
thoughts and behaviors.

Recent research has found that escitalopram, known as Lexapro, was associated with better recovery from
depressive symptoms among adolescents 12 to 17 years of age than a placebo control, and was not
associated with greater adverse effects. The two antidepressants approved for use in adolescents are
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Allteensshouldbescreenedfordepression,taskforcerecommendsCNN.com

fluoxetine, known as Prozac, and Lexapro, for individuals starting at age 8 and 12, respectively.
In recommending certain medications and therapies, the Task Force considered studies that held these
treatments up to a number of different standards, such as whether they improved adolescents' quality of life,
physical and social health and also whether they reduced the rates of young people taking their own lives.
"Suicide attempts and completed suicides are a concern with depression in adolescents and they were
considered in the recommendations," Krist said. According to recent data, 17% of high school students in
the United States have seriously considered taking their own life in the last year and 8% have attempted
suicide.

Depression in young children


Although the current guidelines did not recommend screening children younger than 12, they also did not
recommend against it, Krist said. "Our recommendations are really a call for more evidence," for every
aspect of depression in this age group, from screening and diagnosis to treatment and followup, he said.
"Childhood depression is important. If families are concerned their child is depressed we want them to talk
with their clinician, or if a clinician is concerned we want them to do further evaluation and treatment as
needed," Krist said.
One of the questions that remain is how common depression is among children under 12 years of age.
About 8% of adolescents have suffered depression in the last year, according to U.S. surveys, which is
similar to the rate among adults in the United States.
Last month, the U.S. Preventive Services Task Force published new recommendations for depression
screening in adults; it highlighted the importance of screening women who are pregnant or who have
recently given birth.
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