Current Perspectives on the Diagnosis and Treatment of Adolescent Depression in the Primary Care Setting

Depression is a major public health problem in the United States, affecting more than 18 million persons and costing more than $43 billion in treatment costs and lost productivity annually [1]. Historically, depression was considered a phenomenon that only adults experienced; however, research has shown that children and adolescents experience a range of depressive disorders [2] similar to adults [3]. Current population point prevalence rates of depressive disorders in adolescents, including major depressive disorder and dysthymia, range from 0.4% to 8.3% [4]. Although rates of these disorders vary depending on the sample studied and the measures utilized [5], they are routinely found to increase dramatically during the adolescent years [6], reaching levels reported in adults by middle to late adolescence [7]. Approximately 5% of adolescents suffer from major depressive disorder at any point in time, 20% have at least 1 episode of clinical depression by age 18 years, and 65% experience transient or less severe depressive symptoms [7]. These statistics are concerning considering the limited availability of psychiatric specialty care [8]. The high prevalence of adolescent depression and the limited availability of adolescent mental health specialists have resulted in a growing need for primary care providers to recognize, diagnose, and treat depression [9]. In primary care settings, however, few depressed adolescents currently receive effective treatment [10]. This may reflect the fact that many primary care physicians feel uncomfortable treating adolescent depression [11,12], due either to a lack of training or the timeconsuming nature of managing depression in the context of a routine office visit [12]. This article discusses the management of the depressed adolescent in the primary care setting using a clinical case to highlight diagnostic criteria, clinical characteristics, clinical course, and efficacious treatments.