Monday Medical: Depression screenings and teens
April 1, 2018
Anyone can be impacted by depression, including children and teenagers.
About two to six percent of children experience depression before puberty; after puberty, that rate increases to about eight percent.
"It's more common than most people think," said Dr. Sheila Fountain, a pediatrician in Steamboat Springs.
In many cases, depression goes unnoticed. It's estimated that half of teens are undiagnosed, while up to two in three teens don't get the help they need.
But health professionals hope to change that with regular depression screenings. New guidelines from the American Academy of Pediatrics recommend screening children every year starting at age 12.
Below, Fountain outlines what to know when it comes to depression in children and teens.
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What depression looks like
Depression involves much more than simply feeling sad.
"The most common symptoms include irritability or anger or even just feeling cranky," Fountain said. "Teens might lose interest in activities or say they're bored in class."
Other symptoms include changes in appetite and sleep, feeling tired or low in energy, missing or doing poorly in school and experiencing low self-esteem or feelings of worthlessness and guilt.
Typically, multiple symptoms will be experienced for more than two weeks. In the worst cases, children and teens may develop a preoccupation with death.
"It's not always easy to recognize," Fountain said. "Sometimes it just sneaks up on you. But once a teenager has depression, it impacts their entire life."
Why depression strikes
When it comes to depression, it's hard to pinpoint a cause.
"It's not simple," Fountain said. "There are so many different causes that interact to create depression."
Depression can stem from biological issues, including how neurons connect and release chemicals; chronic medical issues such as hypothyroidism, anemia, diabetes and mononucleosis; substance abuse; stress, which is typically social stress for children and teens; and genetics. A family history of depression is one of the biggest risk factors for whether a child will struggle with depression.
"We tell kids, 'It's not your fault. There's not anything you did wrong that caused this, but it's how your brain is working, your genetics, things you don't have control over,'" Fountain said. "And we assure them that they will get better."
Screening for depression
During well-child checks, written questionnaires are given to pre-teens and teens, with questions such as whether they've felt down or uninterested in activities during a period of time.
"They usually are pretty honest," Fountain said. "I feel like they're looking for a place to tell someone. In the doctor's office with a provider they know, they can be honest with how they feel."
Parents shouldn't hesitate to bring a child in for a screening any time they have a concern.
"Family members and primary care providers are the front line in depression screening," Fountain said. "A parent who sees changes should bring their child in to be evaluated, because kids don't often look at their mom or dad and say, 'Hey, I'm depressed. I need help.'"
Don't be discouraged by a diagnosis of depression, treatment is often very successful for children and teens.
"Sixty percent of children and adolescents respond to medication. When you add in cognitive behavioral therapy, that response goes up to 70 percent," Fountain said. "The combination of both therapy and medication is huge, especially in initial treatment."
Regular exercise, a healthy diet, good sleep habits and boundaries with technology are also important.
After a diagnosis of depression, Fountain sees children and teens again in two to four weeks, and regularly after that to check in on their progress.
"We keep them coming back for monitoring so they're not out there alone, navigating this by themselves," Fountain said.
With the right treatment, children and teens often experience positive changes quickly.
"Remission is the goal," Fountain said. "Usually in four to six weeks you're going to see a real improvement in how they feel. And that gives kids and parents a lot of hope."
For more information, Fountain recommends the American Academy of Child and Adolescent Psychiatry's website aacap.org.
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.