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Pediatrics. 2018 Mar;141(3). pii: e20174082. doi: 10.1542/peds.2017-4082.

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and Ongoing Management.

Abstract

OBJECTIVES:

To update clinical practice guidelines to assist primary care (PC) in the screening and assessment of depression. In this second part of the updated guidelines, we address treatment and ongoing management of adolescent depression in the PC setting.

METHODS:

By using a combination of evidence- and consensus-based methodologies, the guidelines were updated in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) revision and iteration among the steering committee, including youth and families with lived experience.

RESULTS:

These updated guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in PC, including (1) active monitoring of mildly depressed youth, (2) treatment with evidence-based medication and psychotherapeutic approaches in cases of moderate and/or severe depression, (3) close monitoring of side effects, (4) consultation and comanagement 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 the grade of its evidence base are summarized.

CONCLUSIONS:

The Guidelines for Adolescent Depression in Primary Care cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist PC 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 depressed youth in PC is needed, including the usability, feasibility, and sustainability of guidelines, and determination of the extent to which the guidelines actually improve outcomes of depressed youth.

PMID:
29483201
DOI:
10.1542/peds.2017-4082

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: In the past 2 years, Dr Jensen has received royalties from several publishing companies: Random House, Oxford University Press, and APPI Inc. He also is part owner of a consulting company, CATCH Services LLC. He is the chief executive officer and president of a nonprofit organization, the Resource for Advancing Children’s Health Institute, but receives no compensation. Dr Zuckerbrot works for CAP PC, child and adolescent psychiatry for primary care, now a regional provider for Project TEACH in New York State. Dr Zuckerbrot is also on the steering committee as well as faculty for the REACH Institute. Both of these institutions are described in this publication. Drs Cheung and Zuckerbrot receive book royalties from Research Civic Institute.

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