Mental Disorders and Learning Disabilities in Children and Adolescents: Depression in Adolescents

Rates of depression and suicide in adolescents have increased over the past decade, particularly among adolescent girls. Because depression frequently is underdiagnosed, the US Preventive Services Task Force recommends that physicians screen all adolescents ages 12 to 18 years at least annually for major depressive disorder. Adolescents with suicidal thoughts should work with their health care team and family members to create a safety plan that emphasizes a safe environment and provides for escalating levels of support in times of crisis. Patients who are suicidal may need emergency psychiatric evaluation. Management of depression should be guided by symptom severity. Mild depression may improve with brief, supportive appointments in the family medicine office. Moderate to severe depression likely will improve with a combination of cognitive behavioral therapy and a selective serotonin reuptake inhibitor. Fluoxetine and escitalopram are approved by the Food and Drug Administration for management of depression in adolescents. Pharmacotherapy typically is well tolerated but drug or dosage changes may be necessary based on adverse effects. The majority of adolescent patients respond well to treatment. Drug treatment should be continued for 9 to 12 months after symptom improvement.