Guidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management

Amy H. Cheung, Rachel A. Zuckerbrot, Peter S. Jensen, Kareem Ghalib, Danielle Laraque, Ruth E.K. Stein, Anthony Levitt, Boris Birmaher, John Campo, Greg Clarke, Dave Davis, Angela Diaz, Allen Dietrich, Graham Emslie, Bernard Ewigman, Eric Fombonne, Sherry Glied, Kimberly Eaton Hoagwood, Charles Homer, Miriam KaufmanKelly J. Kelleher, Stanley Kutcher, Michael Malus, James Perrin, Harold Pincus, Brenda Reiss-Brennan, Diane Sacks, Bruce Waslick, David Fassler, James McIntyre, Judy Garber, Vicky Wolfe, Johanne Renaud, Debbie Ebner, Stanford Friedman, Terry Stancin, Kathryn Salisbury, Michael Faenza, Susan Bergeson, Darcy Gruttadaro, Sandra Spencer, Elizabeth Hawkins-Walsh

Research output: Contribution to journalArticle

181 Scopus citations

Abstract

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methodologies, guidelines were developed in 5 phases as informed by (1) current scientific evidence (published and unpublished), (2) a series of focus groups, (3) a formal survey, (4) an expert consensus workshop, and (5) revision and iteration among members of the steering committee.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.

Original languageEnglish (US)
Pages (from-to)e1313-e1326
JournalPediatrics
Volume120
Issue number5
DOIs
StatePublished - Nov 1 2007

Keywords

  • Adolescents
  • Depression
  • Guidelines
  • Primary care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Ghalib, K., Laraque, D., Stein, R. E. K., Levitt, A., Birmaher, B., Campo, J., Clarke, G., Davis, D., Diaz, A., Dietrich, A., Emslie, G., Ewigman, B., Fombonne, E., Glied, S., Hoagwood, K. E., Homer, C., ... Hawkins-Walsh, E. (2007). Guidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management. Pediatrics, 120(5), e1313-e1326. https://doi.org/10.1542/peds.2006-1395