Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and ongoing management.
OBJECTIVE
To develop clinical practice guidelines to assist primary care clinicians in the management of adolescent depression. This second part of the guidelines addresses treatment and ongoing management of adolescent depression in the primary care setting.


METHODS
Using a combination of evidence- and consensus-based methodologies, guidelines were developed in 5 phases as informed by (1) current scientific evidence (published and unpublished), (2) a series of focus groups, (3) a formal survey, (4) an expert consensus workshop, and (5) revision and iteration among members of the steering committee.


RESULTS
These guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in primary care, including (1) active monitoring of mildly depressed youth, (2) details for the specific application of evidence-based medication and psychotherapeutic approaches in cases of moderate-to-severe depression, (3) careful monitoring of adverse effects, (4) consultation and coordination of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and its evidence base are summarized.


CONCLUSIONS
These guidelines cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist primary care clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of youth with depression in primary care is needed, including the usability, feasibility, and sustainability of guidelines and determination of the extent to which the guidelines actually improve outcomes of youth with depression.
Cheung
Amy H
AH
University of Toronto, Department of Psychiatry, 33 Russell St, 3rd Floor Tower, Toronto, Ontario, Canada M5S 2S1. amy_cheung@camh.net
Zuckerbrot
Rachel A
RA
Jensen
Peter S
PS
Ghalib
Kareem
K
Laraque
Danielle
D
Stein
Ruth E K
RE
D000293:Adolescent; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards; D011320:Primary Health Care / Q000379:methods* / Q000592:standards*; D016896:Treatment Outcome