Depression and Anxiety in Teens

Clinical depression and anxiety are on the rise among adolescents ages 12-17, as well as instances of self-harm. Here, we offer some insight into the importance of recognizing the signs of depression and anxiety in teens, which are often different from those of adults, as well as some of the differences in diagnosis and treatment.

Diagnosing Anxiety and Depression in Teens
“The diagnostic process is the foundation of effective treatment that goes across any specialty, including anxiety and depression in adolescents. However, teens can present with different symptoms than adults and there are select FDA approved medications for treating youth,” said Asif S. Choudhary, M.D., a child and adolescent psychiatrist with WellStar Health System. “Therefore, the overall assessment is crucial — documenting the patient’s prenatal, developmental, family, substance abuse, psychiatry review of systems and medical history is key in order to move towards the right diagnosis. Sometimes it can be difficult to get this information when treating an adolescent patient.”

Choudhary notes that teens are often reluctant to share the true reasons behind their anxiety or depression and are very protective of their privacy. Since conducting a formal interview is one of the most critical steps toward making a diagnosis, he says it is important to establish a rapport with the patient that helps build trust and makes them feel safe enough to open up.

“For example, a teen isn’t likely to speak freely if the parent sitting next to them is abusive. Or the child may not want to admit to drug or alcohol use in front of the parent,” Choudhary says. “Separating the patient from the parent helps the doctor start building rapport in an environment that is confidential and safe.”

Ferreting out the patient’s medical history, including medication and substance use, is another important step toward making a diagnosis. Underlying health problems can play an unseen role in causing anxiety or depression.

“Could the patient have another health problem that is making them depressed? Are they on medications for illnesses that could be causing anxiety or worsening mood? These are important questions we must ask when conducting an assessment,” Choudhary noted. “A full medical work-up is imperative to make sure we’re not missing anything like thyroid problems or infectious causes, for example.  Checking Vitamin D, B12, lead levels can also be beneficial.”

Choudhary adds that risk assessment will have a role in determining the course of treatment for any patient.

“How acute is the situation? The examining physician has to determine whether or not the patient’s level of risk requires inpatient treatment,” he says. “Sometimes outpatient monitoring is more appropriate, making sure that the patient has been educated about medications and side effects and sets goals for treatment.”

Choudhary says that today’s youth face a barrage of negative influences that affect them in ways we could not have imagined before.

“We are seeing depression, especially, more often in adolescents. They have trouble coping with a variety of stressors that include their social situations.  Examples can range from virtual and real life bullying to their family dynamics,” he said. “Also, there is still a huge stigma regarding mental illness across the world. It’s so important not to make the patient feel like an outcast, especially if they are part of a culture or religion that casts shame on someone who struggles with a mental illness.”

Treatment protocols for teens with anxiety or depression are dependent on the overall health and risk assessments and may include medications, psychotherapy or a combination thereof.

“Therapy and medication have proved more effective together than alone, and it’s important for the physician to help the patient establish realistic expectations for treatment,” notes Choudhary. “But the patient being vested and compliant in the treatment plan are the most important factors for success.”

There are some simple, common-sense remedies that doctors can recommend to families to put into place to help children deal with normal, everyday stress and perhaps ward off the bigger problems of anxiety and depression.

“An important thing parents can do for their children is to spend time with them, just talking and connecting,” Choudhary said. “Exercise is a free antidepressant, so encourage children to spend time outdoors, make it a family activity. Sleep is also very important; electronic devices are terrible for sleep hygiene, so make sure TVs, phones, tablets and laptops are turned off before bedtime.”

Teen Depression Guidelines Help Physicians Tackle Mental Health Issues
As many as one in every five teens experience depression at some point during adolescence, but they often go undiagnosed and untreated, sometimes because of a lack of access to mental health specialists.

Recognizing that pediatricians and other primary care providers are often in the best position to identify and help struggling teens, the American Academy of Pediatrics (AAP) recently published updated medical guidelines on adolescent depression. The “Guidelines for Adolescent Depression in Primary Care,” divided into two parts, were developed by a North American steering committee of researchers and clinical experts that included the AAP, the Canadian Pediatric Society and psychiatric associations from both countries.

This is the first update to the guidelines in 10 years, serving as a tool for physicians and offering recommendations for the patient and family members’ participation.

“A lot of parents go to their pediatrician for the scraped knees and sore throats but don’t think of them when it comes to seeking help for emotional and behavioral issues,” says Rachel Zuckerbrot, M.D., FAAP, a lead author of the guidelines. “The American Academy of Pediatrics is supporting pediatricians so that they are prepared to identify and treat these types of issues.”

The guidelines are targeted for youth ages 10-21 and distinguish the differences between mild, moderate and severe forms of Major Depressive Disorder. The guidelines for the first time also endorse a universal adolescent depression screening for children age 12 and over, which already is recommended by the AAP.

Recommendations include:

• Providing a treatment team that includes the patient, family and access to mental health expertise.
• Offering education and screening tools to identify, assess and diagnose patients.
• Counseling on depression and options for management of the disorder.
• Developing a treatment plan with specific goals in functioning in the home, peer and school settings.
• Developing a safety plan, as needed, which includes restricting lethal means, such as firearms in the home,  and providing emergency communication methods.
• While the guidelines suggest ways to involve family members in a teen’s mental health treatment, they also recommend that the pediatrician spend time alone with the adolescent.

“We would like to see teens fill out a depression screening tool as a routine part of their regular wellness visit,” says Amy Cheung, M.D., a lead author of the study. “Parents should be comfortable offering any of their own observations, questions or concerns, which will help the physician get a well-rounded picture of the patient’s health.”

Pediatricians may be especially vigilant in monitoring teens who have a family history of depression, trauma, substance use or adversity. The guidelines also provide direction for physicians on when to consult with mental health care providers, based on the severity of psychiatric disorder.

“There are often community mental health resources that families and physicians can consult to obtain the best possible care,” Dr. Zuckerbrot says. “The earlier we identify teenagers who show signs of depression, the better the outcome.”

New Documentary Raises Awareness About Anxiety in Teens
Angst, an IndieFlix Original documentary, is intended to foster community discussions about anxiety and its affect on children and teens. The film, comprised of interviews with children, teens, educators, experts and parents, also includes a special dialogue with decorated Olympic swimmer Michael Phelps and his personal struggle with depression and anxiety.

Its purpose is to help people identify and understand the symptoms of anxiety and encourage them to reach out for help. The film’s message is one of hope – that anxiety is treatable at any age.

Angst is being screened in schools, communities and theaters around the world, including several throughout Georgia. For more information, visit angstmovie.com.