Preteen and Teen Depression Treatment
Depression isn’t just for adults anymore. It affects one of every thirty three children and one in eight adolescents. Children and adolescents with a family history of depression are at a higher risk for developing the disorder themselves. Those who experience the stress of a significant loss, or those who suffer from attention deficit, anxiety, or learning disorders or other behavioral conditions are at higher risk.
Symptoms of depression in children and adolescents can sometimes differ from those in adults. Child and adolescent psychiatrists ask parents to look for signs of depression that involve changes in behavior, such as:
- decreased interest in activities
- extended periods of sadness
- low energy
- lack of communication
- social isolation
- increased irritability
- inability to concentrate
- feelings of guilt
- lower self-esteem
- frequent complaints of physical illness
- or changes in eating, sleeping or school attendance patterns
Any expression of suicide or an attempt signals depression and should be considered life threatening. In such cases an adult should seek immediate medical attention for the child or adolescent. Although suicide in preadolescents and adolescents is rare, not preventing the tragedy of suicide is unacceptable, especially today when we have more understanding and can effectively treat mental illnesses better than ever before.
When considering diagnoses and treatment, children and adolescents are lumped together, largely because there is little research about depression in children under 12 years old, and no FDA approved antidepressants. Early screening by a primary care physician or health care provider is the first step toward treating depressed children and adolescents. Some primary care providers feel comfortable in treating the child or adolescent in the primary care setting. This approach can be highly effective. Under some circumstances, however, a provider may choose to refer the child to a qualified psychologist or psychiatrist for diagnosis and treatment. This is particularly true for younger children and in cases where the child or adolescent has not responded to treatment, expressed suicidal thoughts, or other psychiatric comorbidity.
Like adults, their treatment can include a combination of psychotherapy and antidepressants. Cognitive Behavioral Therapy (CBT) has been shown to be the most effective form of psychotherapy for depression. So far, the only FDA approved antidepressant for children over 12 is fluoxetine hydrochloride, sold under the brand names Prozac and Sarafem. Still, many specialists and primary care providers commonly and safely prescribe the same serotonin reuptake inhibitors (brand names Celexa, Luvox, Paxil or Zoloft) used by adults for children and adolescents.
Children and adolescents often show response to antidepressants in four to six weeks. However, a provider should encourage parents to continue medicating their child until instructed to stop. The current recommendation for adults is that patients remain on antidepressant medication for at least 6 to 12 months after full remission of symptoms. This may also apply to children and adolescents. Further research is needed in this area. When treatment is completed, parents and caregivers should monitor the child for a recurrence of depressive symptoms and seek medical care promptly if needed.
As a case manager reviewing a child’s treatment for depression, you should look for documentation of a comprehensive evaluation by a psychiatrist, psychologist or other qualified mental health provider. Medical clearance by the primary care provider (PCP) should be documented. The care manager should also confirm that the behavioral health provider has communicated with the PCP about the child’s diagnosis and treatment plan. When reviewing the treatment plan, look for a combination involving psychotherapy (ideally CBT) and/or antidepressants.
Family education and involvement are also important. The initial treatment episode will generally last at least six months depending upon the patient’s response. When reviewing medications, be sure to document the name and dose of the medication, when it was started, and the patient’s response. Physicians will generally use lower doses and titrate more slowly than with adults. If in doubt, always consult with an experienced psychiatrist for guidance about managing the case.