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) has 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.

The “Guidelines for Adolescent Depression in Primary Care:(GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management,” and “Guidelines for Adolescent Depression in Primary Care:(GLAD-PC): Part II. Treatment and Ongoing Management,” will be published in the March 2018 issue of Pediatrics (Feb. 26 online).

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,” said Rachel Zuckerbrot, MD, 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 to 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 ages 12 and older, 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,” said Amy Cheung, MD, also a lead author. “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, according to the guidelines.

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 said. “The earlier we identify teenagers who show signs of depression, the better the outcome.”