Depression in Teenagers: Experts Say to Screen All

About half of all mental illnesses arise by age 14. A new guideline asks pediatricians to be on alert.

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The new recommendation comes with a serious caveat: that adolescents should be screened only "when systems are in place to ensure accurate diagnosis, psychotherapy, and follow-up," the panel said. Otherwise, says Calonge, "you just identify the problem and you haven't done anything [else]. Plus, we don't want people just pulling out the prescription pad, because there's a concern that [medication] may do more harm than good; we're just worried about that." Calonge's group found "convincing evidence" that a commonly prescribed class of antidepressants—selective serotonin reuptake inhibitors [SSRIs]—can raise the risk of suicidal thoughts or actions in adolescents, which is why the task force urged that those drugs, though often effective, should be considered only when young patients can be closely supervised.

Since news of the screening recommendation broke, the Internet has been abuzz with impassioned comments from people concerned that universal screening will lead to overdiagnosis, even misdiagnosis. One writes, "If you screen every teen for depression there will be one result: All teens are depressed." Calonge says there's little chance of that happening.

Parents shouldn't assume that their child's mental health is being assessed during routine checkups. There are several factors that may hamper widespread implementation of the new recommendation: For one thing, primary-care doctors may not feel prepared to handle their young patients' mental health issues, says Van Voorhees. And mental health professionals trained to diagnose and treat children and adolescents are in short supply and often have lengthy waiting lists, which can make referral tricky.

So parents remain a necessary early warning system. "If you see your kid having some impairment, having some symptoms, by all means get them to someone who can help," says Oscar Bukstein, a child and adolescent psychiatrist and an associate professor of psychiatry at the University of Pittsburgh School of Medicine. "If you look at the natural history of depression, you find that there's a marked increase in the onset of depression in adolescence, post-puberty," he says, "and that many, if not most people who have recurrent depression will often point to adolescence as a point of onset." Roughly half of all mental illnesses arise by age 14, as Jones's did. Finding kids like her is bound to save lives.