This story grapples with a complex issue – screening and treatment of major depressive disorder in adolescents. The case study is useful in stimulating reader interest but ends up muddying the waters – focusing on the specifics of this individual’s treatment, the notion of parental informed consent for screening, and a fairly blanket condemnation of antidepressants.
The story would have better served the interests of readers if it had informed about the strength of the evidence about screening and treating this particular vulnerable population.
What was the evidence that steered the US Preventive Services Task Force – normally slow to endorse screening recommendations – to promote it in this case? To find out if screening "works," the best quality evidence would come from randomized clinical trials of screening versus no screening. But the USPSTF created an analytic framework that coupled the performance of screening instruments with the separate data on the effectiveness of treatments. The article doesn’t give any data/evidence used to support the recommendation.
There was no indicating of treatment costs or whether it was commonly covered by insurance.
The story did not provide any information about the success rates associated with any of the treatments discussed. A number needed to screen should be available. Is it 100 that need to be screened to achieve one additional depression remission? Or what is it?
While indicating that the use of SSRI medication by adolescents has been associated with increased risk of suicide, the story provided no quantitative information about how likely this is to occur. The story did mention the potential for over-prescribing of antidepressants. However, it did not mention other potential harms such as stigma, mis-diagnosis, distracting from more important health problems, and treatment without adequate follow-up potentially leading to net harm.
This article did not accurately report on the recommendations by the USPSTF on mental health screening for adolescents. The text of the story said that ‘Screening made sense only if the children then had access to the kind of specialized and individualized care that Caroline Downing received’. Given that the story mentioned that the treatment of this individual involved art therapy, one could logically conclude that the USPSTF recommendation was for art therapy. The USPSTF guidelines recommended screening for major depressive disorder was for adolescents, ages 12 -18, and there was insufficient evidence to evaluate the balance of risks and benefit for screening children, ages 7-11. Secondly – the recommendation is for screening only when there are systems in place to ensure accurate diagnosis, psychotherapy (cognitive behavioral or interpersonal) and follow-up. It goes on to indicate that there is adequate evidence for treatment in adolescents with selective serotonin inhibitors, psychotherapy, or a combination of the two. Thus, while the story appears to suggest that Caroline’s sister did not receive currently recommended therapy, while Caroline did receive appropriate therapy, this is not supported by the language of the current guidelines.
In addition – to know if screening "works," the best quality evidence would come from randomized clinical trials of screening versus no screening. Beyond giving us the name of the group promoting the guidelines, it should have explained the nature of the data supporting the recommendation.
The story mentions that mental health problems are a major health issue in adolescents. The article reports rates of positive tests from the Teen Screen project and these numbers are high. The story could have been strengthened if it discussed that diagnostic certainty for depression in childrenis a bit less than for adults and that the screeners are not as accurate.
A number of mental health experts, several of whom served on major organization review panels on this topic.
The story did not clearly delineate the treatment options for managing major depressive disorder in adolescents. It should have indicated that serotonin re-uptake inhibitors, psychotherapy, and a combination of the two are all currently recommended for this age group. Omitting combination treatment is especially problematic.
The story failed to provide information about the availability of recommended treatments for major depressive disorder in adolescents. It provided some information about vendors that provided testing for this target population, but it was unclear from the piece where someone ought to turn for help with this. It would have been worth mentioning that therapists specializing in adolescents are in short supply.
The story discussed treatments that are not novel; it did not portray them as such. A novel aspect is extending screening to adolescents.
Does not appear to rely on a press release.