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Undiagnosed and untreated depression affects as many as 1 in 5 teenagers, which has led the American Academy of Pediatrics to publish updated guidelines for pediatricians and other primary care providers who are best positioned to help these youth.

The two-part guidelines assist providers in identifying and treating depression in patients between the ages of 10 and 21. They also remind parents that pediatricians are equipped to treat not only physical health but mental as well.

"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," Dr. Rachel Zuckerbrot, a lead author of the guidelines, said in a statement. "The American Academy of Pediatrics is supporting pediatricians so that they are prepared to identify and treat these types of issues."

Dr. Valerie Arnold, chief of child and adolescent psychiatry at the University of Tennessee Health Science Center, said she's excited the guidelines encourage providers to address an important problem that too often goes unidentified.

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Form a treatment team

Offer training and screening tools

Counseling and management

Create a treatment plan with goals

Develop an emergency plan

"It is not uncommon or unexpected for adolescents to have depression at some point in their adolescent period," she said. "I want pediatricians and primary providers to be comfortable talking about depression and thinking about it in their head when they meet an adolescent."

Compounding the issue, Arnold said, is that some symptoms of depression — apathy, mood swings, fatigue, social isolation and changes in appetite — are written off as "normal" teenage behavior, so providers may be able to pick up on signs missed by friends and family members.

"When you're an adolescent, you tend to start pulling away from your family," she said. "It's really typical for adolescents who have major depression to not say 'I'm depressed' but say 'I'm bored.'"

Early detection leads to better outcomes, and primary care providers who initiate treatment when appropriate could fill gaps where access to mental health specialists is limited.

"We know mental health services in the United States are severely lacking," said Dr. John Heise, an adolescent medicine specialist at Children's Hospital at Erlanger. "There are some mental health facilities, social workers, psychologists, psychiatrists that are available, but they sometimes are hard to get to."

The guidelines also endorse a universal depression screening for children age 12 and over, something Heise said should happen on a yearly basis.

"It's been recommended that adolescents should get an annual physical, and most teenagers do not," he said, adding that urgent care visits and sports physicals typically aren't sufficient.

"The screening is a stepping stone," Heise said. "When you come in and get a blood pressure reading, even if it's high, that doesn't mean you necessarily have hypertension, but that's your first step — this should now be thought of like that."

To manage adolescent depression, the guidelines suggest a "treatment team" that includes the patient, family and access to mental health expertise, but also recommend the pediatrician spend time alone with the adolescent.

"This is the way that the teenager is getting some control and also starting to become responsible for their own health care," Heise said.

Treatment may include antidepressants, counseling or a combination of therapies.

Although the problem of adolescent depression isn't new, Heise said the push for more awareness among paediatricians is growing.

"But if they feel that they've reached beyond their comfort in training, or [patients] are not responding as they're expecting with counseling, medication, or both of them," he said, "then that's a time to make a referral."

Contact staff writer Elizabeth Fite at efite@timesfreepress.com or 423-757-6673.

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