Helping Teens with Depression

A recent study published in Pediatrics set off alarm bells for many people who care for teens and young adults. The researchers found an increase in the rate of depression in this population between 2005 and 2014. The most dramatic rise was in girls ages 12 to 18.

Yet, despite the rising numbers of young people facing depression, the study found no correlating increase in the number of teens or young adults seeking treatment. This is worrisome to the study’s authors, who called for more outreach efforts from pediatricians and school health services.

“Overall, I think many Massachusetts pediatricians are doing an excellent job of diagnosing and managing depression in young people,” says Oscar Bukstein, MD, MPH, associate psychiatrist-in-chief and vice chairman of psychiatry at Boston Children’s Hospital. “We’re going in the right direction, but we have a huge population. There’s really no other chronic condition that affects such a large percentage of the population. And the numbers are rising.”

What’s causing the spike?

The Pediatrics study cites the increased use of cell phones and texting as a possible reason for the uptick in depression, especially in teen girls, who are more frequent users of texting programs.

Bukstein says he’s seen a steady rise in depression in young people over the past 25 years, as the stress of daily life increases. He sees increased reliance on cells phones and social media may be part of this stress.

“While I don’t think they are necessarily a cause of depression, cell phones and social media certainly make our lives more complex and increase the demands on our time. It’s just one added stressor,” says Bukstein. “There’s that sense of constantly needing to being aware, and I hear about the urgency of social media much more from girls than from boys.”

However, Bukstein notes that the rates of depression have always been higher in girls. “Before puberty, the rates are about even. After puberty, girls are twice as likely as boys to have depression. We’re not exactly sure why, but it may have something to do with hormonal changes.”

Five tips for your practice

Bukstein says pediatricians are in a unique position to provide help for kids who may be feeling depressed.

“Kids often feel more comfortable with their pediatrician, and they don’t carry the same stigma that psychiatrists sometimes still have.”

“The ideal setup is for pediatricians to treat mild to moderate depression, while specialists treat more severe cases.

He offers five tips to keep in mind when diagnosing and managing depression in teens and young adult patients.

1. Use screenings

Bukstein says the Patient Health Questionnaire (PHQ-9) is a very simple and useful tool for diagnosing depression. “You can have patients complete the PHQ-9 electronically or on paper,” he says, but recommends against asking the questions face to face. “It can help if the kids don’t have to look you in the eye while talking about their symptoms.”

2. Treat depression early

For pediatricians, the biggest thing is early detection and treatment. “Doctors should be willing, even in mild cases, to refer a kid for therapy,” says Bukstein. For mild depression, he recommends trying therapy before jumping in with medication. Kids with moderate to severe depression usually do best with a combination of medication and therapy.

3. Know when to refer

“The ideal setup is for pediatricians to treat mild to moderate depression, while specialists treat more severe cases,” says Bukstein. He says kids who are suicidal or who don’t get better with first-line treatment by a primary care practitioner should be referred to a specialist. This includes those who have been on medication for four to eight weeks, or who have had at least four sessions of therapy. Kids who have any additional mental health condition, such as bipolar disorder or any type of psychosis, also need to be referred.

4. Monitor medication

If you prescribe medication for patients, it’s important to monitor their progress and side effects and to let parents know what to watch for. “As a clinician, you have to be very truthful about the possibility of negative side effects occurring,” says Bukstein. “But it’s also important to make sure parents look at the big picture — let them know that kids who benefit from these medications far outnumber those who have problems. There’s a high ratio of benefit.”

5. Consider extra training

Many doctors initially feel some trepidation about talking with kids about depression and suicide. Bukstein says a little extra training often goes a long way. “Many of our pediatricians in the Boston Children’s-affiliated practices who have gone through the behavioral health learning community have found it’s not so hard to develop these skills. In fact, we find that doctors who increase their skills often want to learn even more.”

Learn more about Boston Children’s Outpatient Psychiatry Services.