Adolescent Depression Screenings: Let's talk about it!

It's not news that teen depression is a growing problem, one that must not be ignored. But what about screening of adolescents for mental health conditions? Is that something that should be required? Optional?

This is an issue that I think we need to discuss here, through comments to this post. It's my belief that discussion often gives us deeper understanding of issues we thought we understood well enough. Sometimes, discussion and considering what others are saying can even lead us to change our own thoughts on the issues.

So, to get this discussion going, let me provide some background.

Because Candace Downing was experiencing anxiety during exams at school, a child psychiatrist prescribed Zoloft for her after a very brief evaluation. When Candace turned 12, the same psychiatrist increased her dosage on the grounds that it would help her academically. When Mrs. Downing expressed concerns about the drug, she said the doctor blew her off: "He said, 'What are you worried about? It is safe and effective.' "

One day in 2004, after watching an innocuous television program with her father and sister, Candace went to her room and took her own life. Her mother believes it was because of an adverse reaction to the antidepressant Zoloft. Not long afterward, her sister Caroline started having issues at school -- her mind wandered, and she would freeze up during math tests. School officials suggested that she be screened for possible mental health issues.

Because of what had happened to Candace, Mrs. Downing was understandably upset by and hesitant to agree to a psychiatric evaluation for Caroline. No way did she want to be part of it if Caroline were going to get the same mental health care as Candace. Mrs. Downing agreed to have her older daughter screened because Caroline was obviously in distress, but told school officials that if the evaluation led to medications being prescribed, she would refuse.

It came as no surprise that the screening found that Caroline's emotional problems were linked to her sister's death. Several intensive evaluations that examined her mental and emotional history, a family history, and detailed information about Candace's death, art therapy was recommended for Caroline. She began this therapy, which involves painting or sculpting with a therapist who uses the sessions to draw out patient's issues, issues that they may not even be aware of, let alone understand.

The art therapy was immediately helpful to Caroline, and Mrs Downing, who started out skeptical at best, became  "a fan of mental health treatment done right." Caroline agreed that it had helped her a great deal:

"My grades went from almost failing algebra to honor roll... getting all the stuff out of your head that you don't need there gives you more room for all the stuff you need to have in your head." ~~ Caroline Downing

That Candace and Caroline had such vastly differing results from the screenings, shows an issue that's at the core of the debate about new screening guidelines. It's not whether screenings are done that has the biggest impact. The biggest impact is how the screening is done and how the results are used.