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Doctors describe treatment options for adolescent depression

(Reuters Health) – When a teen is diagnosed with depression, it’s normal for parents to feel overwhelmed and to search for information about which treatment options are best, doctors write in a new patient resource published in JAMA Pediatrics.

Although depression affects about 20 percent of adolescents, many don’t seek help and hesitate to talk to their parents about what they’re experiencing, the authors note.

“Many adolescents don’t seek treatment for many reasons, and those who do come to our office often say they don’t want to tell mom or dad because they’re already dealing with so much,” said Dr. Ana Radovic of the Children’s Hospital of Pittsburgh in Pennsylvania, who co-wrote the patient resource.

“Parents may also feel guilty that they’re the reason for the depression, especially when it comes to divorce,” Radovic told Reuters Health in a phone interview. “At the same time, they need to realize they’re not in control of everything that happens in their child’s life.”

Available for free, the new patient page ( offers practical advice about options parents should consider to help their teen, noting that adolescent depression differs from adult depression in symptoms, diagnosis and treatment.

Although it’s normal for teens to become moody, irritable and independent as they enter puberty, extreme changes that lead to withdrawal from friends and activities, as well as expressions of hopelessness or worthlessness, are concerning. These are not typical manifestations of teenage angst.

“It can be difficult for parents to identify the symptoms, especially because teens are going through so many changes that are normal developmentally,” Radovic said.

It’s important for parents to realize that not all depression is the same. So treatment will vary based on multiple factors, including how severe the depression is and whether there are accompanying mental illnesses such as attention-deficit/hyperactivity disorder, anxiety, substance use or bipolar disorder.

In addition, not all therapy is the same. For instance, cognitive behavior therapy is often recommended for children and teens to learn about their depressive thoughts and develop skills to change them. Another type of talk therapy, called interpersonal therapy, focuses on resolving interpersonal problems and social functioning issues. These two therapies have the most evidence for their effectiveness in treating adolescent depression, the patient resource says.

Some adolescents may also benefit from an antidepressant, such as a selective serotonin reuptake inhibitor (SSRI), which are safe medications that have been associated with decreases in suicide rates, the authors point out. Parents, teens and doctors should discuss treatment preferences, depression severity and associated mental or physical illnesses to find the best prescription.

In addition, the patient resource emphasizes healthy sleep, nutrition and exercise. “Teenagers just do not have the cognitive energy to manage depression without enough sleep,” the authors write. And lack of sleep has been associated with worsening depression, especially for teens who must wake up early to attend school daily.

Although lifestyle changes around sleep, diet and exercise may be difficult to enforce with a depressed teen who doesn’t want to get off the couch, there may be strategies to encourage healthy behaviors among all members of the family. Overall, it’s also important to talk to children and teens about depression, anxiety and suicide to open up communication and normalize the conversation related to the topics.

“Parents are afraid that if they talk about suicide with their kids, it’s going to happen, and that’s just not true. Instead, avoiding the subject makes it taboo and unapproachable,” said Maria Silva, chief program officer of the Allegheny Family Network in Pittsburgh, who wasn’t involved with the patient page.

It’s important for parents to find support through a reliable healthcare team and local mental health advocacy parent group such as the National Alliance on Mental Health to help them through the process of supporting their child.

“These groups eliminate the feeling of aloneness and give stories of hope, so you know you don’t have to do it alone,” Silva told Reuters Health by phone. “We’ve seen countless stories of healing as parents and kids come together at meetings and open up communication.”

SOURCE: JAMA Pediatrics, online January 28, 2018.

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