Welcome to NGC. Skip directly to: Search Box, Navigation, Content.


Brief Summary

GUIDELINE TITLE

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and ongoing management.

BIBLIOGRAPHIC SOURCE(S)

GUIDELINE STATUS

This is the current release of the guideline.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Definitions for grades of evidence (A-D) and strengths of recommendation (weak, fair, strong, very strong) are provided at the end of the "Major Recommendations" field.

Treatment

Recommendation 1: After initial diagnosis, in cases of mild depression, clinicians should consider a period of active support and monitoring before starting other evidence-based treatment (grade of evidence: B; strength of recommendation: very strong).

Recommendation 2: If a primary care (PC) clinician identifies an adolescent with moderate or severe depression or complicating factors/conditions such as coexisting substance abuse or psychosis, consultation with a mental health specialist should be considered (grade of evidence: C; strength of recommendation: strong). Appropriate roles and responsibilities for ongoing management by the PC and mental health clinicians should be communicated and agreed upon (grade of evidence: C; strength of recommendation: strong). The patient and family should be consulted and approve the roles of the PC and mental health professionals (grade of evidence: D; strength of recommendation: strong).

Recommendation 3: PC clinicians should recommend scientifically tested and proven treatments (i.e., psychotherapies such as cognitive behavioral therapy [CBT] or interpersonal therapy [IPT] and/or antidepressant treatment such as selective serotonin reuptake inhibitors [SSRIs]) whenever possible and appropriate to achieve the goals of the treatment plan (grade of evidence: A; strength of recommendation: very strong).

Psychotherapies

Antidepressant Treatment

Recommendation 4: PC clinicians should monitor for the emergence of adverse events during antidepressant treatment (SSRIs) (grade of evidence: B; strength of recommendation: very strong).

Ongoing Management

Recommendation 1: Systematic and regular tracking of goals and outcomes from treatment should be performed, including assessment of depressive symptoms and functioning in several key domains: home, school, and peer settings (grade of evidence: D; strength of recommendation: very strong).

Recommendation 2: Diagnosis and initial treatment should be reassessed if no improvement is noted after 6 to 8 weeks of treatment (grade of evidence: B; strength of recommendation: very strong). Mental health consultation should be considered (grade of evidence: D; strength of recommendation: very strong).

Recommendation 3: For patients who achieve only partial improvement after PC diagnostic and therapeutic approaches have been exhausted (including exploration of poor adherence, comorbid disorders, and ongoing conflicts or abuse), a mental health consultation should be considered (grade of evidence: D; strength of recommendation: very strong).

Recommendation 4: PC clinicians should actively support depressed adolescents who are referred to mental health to ensure adequate management (grade of evidence: D; strength of recommendation: very strong). PC clinicians may also consider sharing care with mental health agencies/professionals when possible (grade of evidence: B; strength of recommendation: very strong). Appropriate roles and responsibilities regarding the provision and coordination of care should be communicated and agreed upon by the PC clinician and the mental health specialist (grade of evidence: D; strength of recommendation: very strong).

Definitions:

Grades of Evidence

Each recommendation is graded on the basis of the Oxford Centre for Evidence-Based Medicine grade of evidence (A–D) system (see www.cebm.net/levels_of_evidence.asp).

Strengths of Recommendation

The strength of each recommendation, in terms of the extent to which experts agreed that the recommendation is highly appropriate and a "first-line" practice, was reached for each recommendation. Recommendation strength was rated in 4 categories:

  • Very strong (>90% agreement)
  • Strong (>70% agreement)
  • Fair (>50% agreement)
  • Weak (<50% agreement)

CLINICAL ALGORITHM(S)

The original guideline document contains a "Clinical Management Flowchart."

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is identified and graded for each recommendation (see "Major Recommendations").

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2007 Nov

GUIDELINE DEVELOPER(S)

Guidelines for Adolescent Depression in Primary Care (GLAD-PC)

SOURCE(S) OF FUNDING

Guidelines for Adolescent Depression in Primary Care (GLAD-PC)

GUIDELINE COMMITTEE

Guidelines for Adolescent Depression in Primary Care (GLAD-PC) Steering Group

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Authors: Amy H. Cheung, MD, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Rachel A. Zuckerbrot, MD, Division of Child Psychiatry, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York; Peter S. Jensen, MD, REACH Institute, Resource for Advancing Children's Health, New York, New York; Kareem Ghalib, MD, Division of Child Psychiatry, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York; Danielle Laraque, MD, Department of Pediatrics, Mount Sinai School of Medicine, New York, New York; Ruth E. K. Stein, MD, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York

GLAD-PC Project Team Members: Peter S. Jensen, MD (project director, REACH Institute); Amy Cheung, MD (project coordinator, University of Toronto/Columbia University); Rachel A. Zuckerbrot, MD (project coordinator, Columbia University); Kareem Ghalib, MD (Columbia University); Anthony Levitt, MD (project consultant, University of Toronto)

GLAD-PC Steering Committee Members: Boris Birmaher, MD (Western Psychiatric Institute & Clinic, University of Pittsburgh); John Campo, MD (Ohio State University and Nationwide Children's Hospital); Greg Clarke, PhD (Center for Health Research, Kaiser Permanente); Dave Davis, MD (University of Toronto); Angela Diaz, MD (Mount Sinai School of Medicine); Allen Dietrich, MD (Dartmouth Hitchcock Medical Center); Graham Emslie, MD (University of Texas Southwestern Medical School); Bernard Ewigman, MD (Department of Family Medicine, University of Chicago); Eric Fombonne, MD (McGill University); Sherry Glied, PhD (Columbia University); Kimberly Eaton Hoagwood, PhD (Office of Mental Health, New York State/Columbia University); Charles Homer, MD (National Initiative for Children's Healthcare Quality); Danielle Laraque, MD (AAP New York Chapter 3, District II/Mount Sinai School of Medicine); Miriam Kaufman, MD (Hospital for Sick Children, University of Toronto); Kelly J. Kelleher, MD (Ohio State University); Stanley Kutcher, MD (Dalhousie Medical School); Michael Malus, MD (Department of Family Medicine, McGill University); James Perrin, MD (Massachusetts Medical School/Harvard Medical School); Harold Pincus, MD (Columbia University/New York State Psychiatric Institute); Brenda Reiss-Brennan, APRN (Intermountain Health); Diane Sacks, MD (Canadian Paediatric Society); Ruth E. K. Stein, MD (Forum for Child Health, New York Academy of Medicine, Albert Einstein College of Medicine); Bruce Waslick, MD, Baystate Health Systems, MA)

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Dr Cheung is on the speakers' bureau of Eli Lilly; Dr Jensen has received several unrestricted educational grants from Eli Lilly, McNeil, and Janssen-Ortho, is a consultant for Shire-Richwood, UCB Pharma, McNeil, and Janssen-Ortho, and is on the speakers' bureau for UCB Pharma, McNeil, and Janssen-Ortho. The other authors have indicated they have no financial relationships relevant to this article to disclose.

ENDORSER(S)

American Academy of Child and Adolescent Psychiatry - Medical Specialty Society
Canadian Academy of Child Psychiatry - Medical Specialty Society
Canadian Association for Adolescent Health - Medical Specialty Society
Canadian Paediatric Society - Medical Specialty Society
Canadian Psychiatric Association - Medical Specialty Society
College of Family Physicians of Canada - Professional Association
Depression and Bipolar Support Alliance - Disease Specific Society
Federation of Families for Children's Mental Health - Medical Specialty Society
Mental Health America - Medical Specialty Society
Mental Health Association of New York City - Professional Association
National Alliance on Mental Illness - Private Nonprofit Organization
National Association of Pediatric Nurse Practitioners - Professional Association
Society for Adolescent Medicine - Medical Specialty Society
Society for Developmental and Behavioral Pediatrics - Professional Association

GUIDELINE STATUS

This is the current release of the guideline.

GUIDELINE AVAILABILITY

Electronic copies: Available from the Pediatrics journal Web site.

Print copies: Available from Amy H. Cheung, MD, University of Toronto, Department of Psychiatry, 33 Russell St, 3rd Floor Tower, Toronto, Ontario, Canada M5S 2S1. E-mail: dramy.cheung@gmail.com.

AVAILABILITY OF COMPANION DOCUMENTS

PATIENT RESOURCES

The following is available:

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC STATUS

This NGC summary was completed by ECRI Institute on May 30, 2008. The information was verified by the guideline developer on August 18, 2008.

COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.

DISCLAIMER

NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.


 

 

   
DHHS Logo