Most depressed teenagers are never seen by a psychiatrist. They are seen, if at all, by a pediatrician or family doctor, and for a long time those doctors had no guidance written for their setting. The Guidelines for Adolescent Depression in Primary Care, GLAD-PC, filled that gap. First published in 2007 by a US–Canadian expert group and endorsed by the American Academy of Pediatrics, they were updated in 2018 and remain the reference for primary care.
Screening
GLAD-PC recommends that every adolescent aged 12 and over be screened for depression once a year with a validated questionnaire, usually the PHQ-9 modified for teens, and that young people with risk factors (family history, chronic illness, substance use, trauma, a previous episode) be watched more closely. Screening should include questions about suicidal thoughts, and every practice needs a plan for what happens when a screen is positive.
Assessment
A positive screen leads to a diagnostic interview with the adolescent alone and with the parents, covering symptoms, duration, functioning at school and home, safety, and other conditions such as anxiety, ADHD or substance use. The guidelines distinguish mild, moderate and severe depression because the treatment differs.
Treatment
For mild depression, “active support and monitoring” for six to eight weeks, with education for the family, is the first step; many episodes resolve. For moderate to severe depression, primary care doctors can start treatment themselves: evidence-based psychotherapy (cognitive behavioural or interpersonal therapy) and, when indicated, an SSRI antidepressant, with fluoxetine as the best-supported choice. Monitoring is specified in detail: weekly contact after starting medication, watching for worsening or suicidal thoughts, and formal reassessment with the same questionnaire.
When to refer
Severe depression, psychosis, bipolar features, substance dependence, active suicidal planning or failure to respond after two adequate trials call for referral to child and adolescent mental health services, with the primary care doctor continuing to coordinate. The 2018 update added guidance on collaborative care models in which a mental health clinician works within the practice, and it strengthened the safety-planning section.
This site is an independent reference on children’s mental health; the full guidelines are published in the journal Pediatrics and on the American Academy of Pediatrics website.
