The prescription for depressed teens who can't get help is more than a shrug

http://www.theguardian.com/commentisfree/2015/sep/10/depressed-teens-need-more-than-a-shrug

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The US Preventive Services Task Force’s reaffirmed recommendation that physicians screen for depression only in those teens who have access to mental health treatment – because, they say, screening for teens without easy access to treatment is useless – will leave countless adolescents who are struggling with depression undetected and un-helped.

Depression, when severe, can significantly undermine functioning in all spheres and end up altering a teen’s life course. Academics, relationships, health, judgment and self-esteem often deteriorate. Many teens suffering from depression resort to self-medicating, which can lead to an additional set of high-risk problems, such as further mood extremes, legal trouble and overdose. Suicide is an occasional and tragic outcome of depression. Despite all these risks, less than 45% of teens with depression get treated for it.

A member of the federal task force says, “Treatment can make a big difference by relieving teens’ symptoms and reducing their risk of suicide.” So why does the task force nevertheless recommend that we not even bother to screen large numbers of struggling teens?

There are always resources available, even if they don’t resemble one-on-one therapy sessions in cozy armchairs: some internists and psychiatric nurses prescribe antidepressant medications when psychiatrists are not accessible or are prohibitively expensive for their patients. (The task force did, on the up side, delete language stigmatizing the use of antidepressants for teens.)

Online resources for depression are abundant and provide education, readings, support groups and links to treatment and other sufferers. Individuals are more likely to create new resources, like an after-school peer support group or a depression awareness day, once they tap into a community that understands and supports them.

Many states made deep cuts to community mental health services after the recession of 2008; from 2009-2012, state spending on mental health fell by $4.35bn. After the school shooting in Sandy Hook, Connecticut, in December 2012, those cuts diminished somewhat, but despite some fund allocations specifically targeted at teen mental health, that trend seems to be receding overall. North Carolina, Nebraska and Louisiana made further cuts to mental health funding in the fiscal years 2014 and 2015.

Given the recurrence of mass shootings in this country in recent years, many perpetrated by young adults and some of which have been attributed to mental illness, these cuts are grossly negligent. We certainly don’t need a federal task force that encourages negligence by taking a passive and hopeless stance toward under-resourced – read: poor – teens.

Physicians bear responsibility to identify symptoms of depression in their patients – and then to act on that information. The task force should, at minimum, provide a treatment protocol for teens who can’t easily connect with specialized treatment. The protocol should include a medication trial, a bridge to the school counselor, family involvement when possible, access to online sites such as The American Psychiatric Association, the American Psychological Association and the Jed Foundation, emergency hotlines and follow-up with the physician.

No one should be considered out of treatment’s reach – and no one should be dissuaded from seeking a diagnosis because treatment is hard to find. Refusing to diagnose teens because we have abdicated our responsibility to make treatment accessible isn’t a solution. It just makes life harder for teens today, and guarantees problems for the adults they become.