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.
"Screening a child to find out what the root of the problem is can be useful ... In the case of my daughter [Caroline], it helped [that] they found a connection between her focusing problems and the death of her sister." ~~ Mrs. Downing
A look at what happened to the Downing family is a look at both the pros and cons of new government guidelines that recommend broad reaching screening of adolescents for mental health issues:
- In April (2009), The U.S. Preventives Services Task Force, which makes public health recommendations, stated that all adolescents between the ages of 12 years and 18 years should be screened for major depressive disorder. The task force added that screening makes sense only if the screened adolescents have access to the individualized specialized care such as the care Caroline Downing received.
- In March (2009), the Institute of Medicine, an advisor to Congress regarding scientific matters, stated that early screening was essential to reducing the "financial and medical burden of mental disorders" in the U.S.
Ned Calonge is a senior member of the task force and chief medical officer of the Colorado Department of Health and Environment. He commented:
"We wanted to recommend against the idea doctors would do a screen and pull out their prescription pad... The recommendation says you have to do really close clinical monitoring. So don't pull out the prescription pad and write an SSRI prescription; the best treatment is psychotherapy.
There is hardly a mental health issue that could be more critical than this one. When children or adolescents need help, the quality of that help shapes the rest of their lives and impacts everyone in their lives. There may be many of us here who, as adolescents, could have been helped a great deal by such screenings followed by appropriate treatment.
Certainly, some of us have children this age who may need help. Some of us ARE in the age range discussed here.
Please, click the "Add Comment" link below to tell us what you think and feel about this issue. Great things can come from such a discussion. Please, let's talk!
Vedantam, Shankar. "The Depression Test." The Washington Post. May 26, 2009.