Managing Anxiety and Depression in Adolescents

Anxiety and depression are both common and commonly missed in children and adolescents. At any given time, 5% of the population under the age of 18 has some symptom of anxiety or depression, said Helena Karnani, MbChb, a practicing physician in the St. Vincent's Family Residency Program in Jacksonville, FL. By the age of 18, 20% of children have had at least one major episode.

"If we don't treat anxiety and depression in our younger patients, it has debilitating effects throughout their lives," she cautioned the American Academy of Family Physicians Scientific Assembly. "Among adults with anxiety, depression, and other mental problems, nearly all exhibited symptoms as adolescents. If we catch these things early, we can make a tremendous difference in their lives."

Why does the burden fall on primary care practitioners?

"In many areas, there just are not enough child psychologists and psychiatrists," Dr. Karnani said. "We are the ones stuck with the problem because there is no one to refer them on to."

Anxiety, depression, and other mental disorders are on the increase. Every successive generation is more depressed, Dr. Karnani said, a result of the increasingly harsh social environment. A growing list of comorbidities, including personality disorders, ADHD, substance abuse, eating disorders, household violence, and sexual abuse add to the burden.

Comorbid conditions frequently present first, she said. That makes it more difficult to diagnose and treat the underlying anxiety or depression.

Asian American children have the lowest levels of anxiety and depression, followed by Caucasians, Latinos, and African Americans. Symptom types vary by race and ethnicity as well.

Anxious or depressed Asian American kids tend to internalize the problem, leading to social isolation and somatic complaints. African American kids, by contrast, tend to externalize problems, resulting in higher levels of aggression.

Family history is a major risk factor. A child with one depressed parent is three times more like to suffer his or her own major event. Risk increases two to four times after puberty, especially in girls.

Children at high genetic risk, it turns out, are more sensitive to adverse environmental effects. Watch for family dysfunction or conflicts between child and caregiver, peer problems, academic difficulties, negative styles of interpreting events, homosexuality in males, and chronic illness.

Pharmacotherapy has become a conundrum, added Heidi Pomm, Ph.D., director of behavioral science at the University of Miami Department of Family Medicine. Publicity over links between antidepressants and suicidality in adolescents has prompted many physicians and parents to halt drug therapy or defer treatment until adulthood.

The reality, she said, is that the risk of suicide from untreated depression is higher than the risk of suicide from antidepressant medications.

"Psychiatrists confirm that because of the black box warning on antidepressants, kids no need drug treatment are not getting it," she said. It is important that we make sure they get access to adequate treatment. If we do not, we may see more suicidal cases."