Teenage depression: are we screening the right kids?
Teenage years are a turbulent time for most people. Some survive the bumpy ride, while some can crash head-on into major depressive episodes. That’s nearly 3 million people according to a 2014 study done by the National Survey on Drug Use and Health. Staggering, yes, but signs also point to this number increasing.
The psychiatric community is split on how to deal with this problem. One side wants universal screening for teenagers with signs of depression, while others feel this can lead to misdiagnosis. And that’s easy enough to see. After all, some teenagers are just being teenagers. It’s a rough time. They can and will be sullen and moody. That doesn’t mean they’re suffering from clinical depression though.
Misdiagnosis can go the other way too. At times, some teens really need help and the adults in their lives, some doctors included, may determine they’re just suffering like any young person does. This can lead to physical illness, dropping grades and poor social behavior. If the depression is severe, some teens can ultimately choose to end their lives.
This age group often can’t describe their feelings. They won’t offer anything up when they know they’ll get labeled for it. Put them in front of a doctor and they clam up even worse. That’s why breaking through with the right questions, handled the right way, is the only way to find the path they’re really on.
When screening for depression is appropriate
The screening process makes sense. If major symptoms for depression are discovered early, treatment is far more effective. It’s important that the correct screening be done however. The two that have been recommended often are the Beck (Youth) Depression Inventory and the Patient Health Questionnaire for Adolescents. Results would indicate that both can help zero in on those with real problems. This can be debated however.
These screening methods don’t necessarily predict or diagnose depression. They do point fingers at the symptoms. This leads to discussion, which can lead to other treatments, both therapy and medications driven, that can finally establish the root of the problem.
It’s important to evaluate the screening performed before starting treatment. Just because it isn’t a silver bullet to diagnose depression doesn’t mean it should be taken out of the equation. There are so many kids that go undiagnosed and never receive any treatment to speak of. Rather than get rid of screening, which some have suggested, it would be better to fill in the missing parts of the system to improve the end results.
Overdiagnosis of depression in teens
The anti-screening crowd are concerned about over-diagnosis and over-medication. There is a tricky balance here, because as we’ve said, the normal sadness a teen experiences doesn’t require drugs. Life happens and it requires developing healthy ways of coping with it. Each teen is unique and each will deal with their ups and downs in the way they chose.
Screening for depression started as a good idea that wasn’t executed very well. Those who endorsed it saw only positives and didn’t really consider the negatives. The thinking was that all teens could be easily categorized and that doing this early enough could prevent spiraling downward to suicide.
But no screening method is going to detect sadness as depression or as normal teenage sullenness. Most results are going to describe the teen patient as being sad some of the time, as feeling worthless, or seeing that his or her life has little purpose, etc. Many teens would state these views, even those without clinical depression. So could this really be accurate? Moreover, their symptoms can change from day to day based on social factors like family and peer pressure. Substance abuse can also play a role in these shifting moods. In the end, who can really say these kids need treatment for depression?
Being diagnosed mentally ill is not an easy label to wear, and a person will be wary of it his or her whole life. It will make a person feel differently about themselves and might make others feel differently about them as well. A diagnosis of clinical depression shouldn’t, therefore, be made lightly. It’s very easy to make a misdiagnosis, but very hard to take one away. Primary care doctors without the time and training to recognize depression over other diagnoses feel the pressure from routine screening processes. So they diagnose and prescribe antidepressants, which can increase risk factors that might not have been present before. In short, they end up creating an illness that isn’t there.
Teenage depression: the big picture
Routine depression screenings that aren’t targeted will lead to mistakes. They aren’t cheap. They can be dangerous. They could create an enormous group of teens with an unnecessary label. And they take valuable resources away from the teens who really do have the illness and desperately need assistance.
Until there is a proven test showing the true depths of sadness that can compare with the true depths of an adolescent’s emotional growing pains, the system needs to be cautious before proceeding down this over-walked path. Right now, targeted screening makes sense. Universal screening, not so much.
If you know of someone who needs help with their child’s depression please call (855) 233-2044