Why Pediatricians' Role in Treating Depression in Adolescents is Critical

Anyone can develop depression-including adolescents.

Depressed youth, compared to non-depressed youth, are at greater risk for suicide, substance abuse, early pregnancy, low educational attainment, recurrent depression, and poor long-term health. But depression is largely underdiagnosed and undertreated in adolescents, with nearly 70 percent of depressed adolescents going untreated, says Dr. Oscar Taube, a board-certified pediatrician/adolescent medicine specialist and coordinator of adolescent medicine at The Herman & Walter Samuelson Children's Hospital at Sinai.

A severe nationwide shortage of child and adolescent psychiatrists underscores the treatment gap and, along with the U.S. Preventive Services Task Force's recommendation that all adolescents (particularly between the ages of 12 and 18) be screened for depression, has made pediatricians' role in recognizing and treating depression increasingly significant.

Taube says it's imperative that pediatricians be familiar with the major signs of depression in adolescents and comfortable with making a diagnosis, referring patients for psychotherapy, and prescribing medication if the patient doesn't seem to be improving with therapy.

"This isn't to knock non-psychiatric therapists. They're wonderful. But they can't prescribe medications," Taube says. "It's something the pediatrician can and should be able to do, and has to do because there's a terrible shortage of child psychiatrists. When it comes to depression, pediatricians need to be as comfortable prescribing depression medications as they are with prescribing attention deficit disorder medications. However, it should be noted that many teens with depression can be treated without medication."

The signs and symptoms of depression in adolescents are similar to those in adults and can include:
 

• Too little or too much sleep
• Loss of interest and pleasure in activities
• Feelings of worthlessness or inappropriate guilt
• Decreased energy or fatigue
• Difficulty concentrating
• Decreased or increased appetite
• Weight changes
• Psychomotor changes (i.e. agitation or retardation)
• Suicidal thoughts

A hurdle in properly treating depressed youth, Taube says, is their reluctance to accept or acknowledge their diagnosis. "I think there's shame and embarrassment associated with a mental health diagnosis. Teenagers want to be normal; they want to be like other teenagers," he says. "Teenagers are extra sensitive in terms of being different."

Taube says effective, early intervention can yield significant short- and long-term benefits. "If you don't address mental health problems in the childhood/teenage years, these young people, as adults, can suffer a host of problems. That's the glass-half-empty way to look on it," he says. "The glass-half-full way to look on it is that effective, early intervention can interrupt a bad progression and change the arc."

The adolescent medicine program at the Samuelson Children's Hospital provides clinical care for young patients with acute and chronic conditions. Consultations are available by phone or appointment. Patients complete a questionnaire prior to their initial visit to the hospital. Our board-certified specialist will then review the patient's medical history, meet with the patient and his or her parents together and individually, examine the adolescent, and provide an assessment and plan. A report also is forwarded to the patient's primary care physician.

You can schedule an appointment with a LifeBridge Health physician by completing our online appointment request form or calling 410-601-WELL.