PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1313-e1326 (doi:10.1542/peds.2006-1395)
SPECIAL ARTICLE |
Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management
a Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
b Division of Child Psychiatry, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York
c REACH Institute, Resource for Advancing Children's Health, New York, New York
d Department of Pediatrics, Mount Sinai School of Medicine, New York, New York
e Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
OBJECTIVES. To develop clinical practice guidelines to assist primary care clinicians in the management of adolescent depression. This second part of the guidelines addresses treatment and ongoing management of adolescent depression in the primary care setting.
METHODS. Using a combination of evidence- and consensus-based methodologies, guidelines were developed in 5 phases as informed by (1) current scientific evidence (published and unpublished), (2) a series of focus groups, (3) a formal survey, (4) an expert consensus workshop, and (5) revision and iteration among members of the steering committee.
RESULTS. These guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in primary care, including (1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and its evidence base are summarized.
CONCLUSIONS. These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist primary care clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of youth with depression in primary care is needed, including the usability, feasibility, and sustainability of guidelines and determination of the extent to which the guidelines actually improve outcomes of youth with depression.
Key Words: adolescents • depression • primary care • guidelines
Abbreviations: PC—primary care • MDD—major depressive disorder • AACAP—American Academy of Child and Adolescent Psychiatry • PCP—primary care provider • GLAD-PC—Guidelines for Adolescent Depression in Primary Care • FDA—Food and Drug Administration • RCT—randomized, controlled trial • CES-DC—Center for Epidemiological Studies Depression Scale for Children • MAOI—monoamine oxidase inhibitor • CBT—cognitive behavioral therapy • SSRI—selective serotonin reuptake inhibitor • IPT—interpersonal psychotherapy • CI—confidence interval
Accepted Apr 16, 2007.
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