---
title: Adolescent Depression Screening
description: A clinical reference for the screening, diagnosis, and management of depression in adolescent patients.
keywords: [adolescent, depression, screening, PHQ-9, SSRI, psychotherapy]
category: clinical
---

## Introduction

Depression is a common and debilitating mental health condition that can have significant impacts on the physical, emotional, and social wellbeing of adolescent patients. Early identification and appropriate management of depression in this population is crucial, as untreated depression can lead to impaired academic and social functioning, substance abuse, self-harm, and increased risk of suicide. This clinical reference provides guidance on the screening, diagnosis, and evidence-based treatment of depression in adolescent patients.

## Screening and Diagnosis

The American Academy of Pediatrics (AAP) recommends universal screening for depression in adolescents aged 12 years and older using a validated assessment tool such as the Patient Health Questionnaire for Adolescents (PHQ-A). The PHQ-A is a 9-item self-report measure that assesses the presence and severity of depressive symptoms over the past 2 weeks. Scores range from 0 to 27, with a score of 10 or higher indicating the presence of clinically significant depression.

Adolescents who screen positive for depression should undergo a comprehensive psychiatric evaluation to confirm the diagnosis and assess for the presence of any co-occurring mental health conditions, such as anxiety, substance use disorders, or suicidal ideation. The evaluation should include a detailed history, physical examination, and laboratory testing as indicated (e.g., complete blood count, thyroid function tests, drug screening). 

The diagnostic criteria for major depressive disorder in adolescents, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), include the presence of at least five of the following symptoms for a period of at least 2 weeks: depressed mood, anhedonia, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicidal ideation.

## Pharmacological Treatment

For adolescents with moderate to severe depression, the first-line pharmacological treatment is a selective serotonin reuptake inhibitor (SSRI) antidepressant. The Food and Drug Administration (FDA) has approved the use of fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro) for the treatment of depression in adolescents. 

The recommended starting dose of fluoxetine is 10 mg once daily, with a target dose of 20-60 mg per day. Sertraline should be initiated at 25 mg once daily, with a target dose of 50-200 mg per day. Escitalopram should be started at 10 mg once daily, with a target dose of 10-20 mg per day. Patients should be monitored closely for the development of adverse effects, such as nausea, headaches, and activation of suicidal ideation, particularly during the first few weeks of treatment.

In cases where an SSRI is not tolerated or is ineffective, alternative antidepressant medications, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) or atypical antidepressants, may be considered. However, the use of these medications in adolescents is generally off-label and should be undertaken with caution and close monitoring.

## Psychotherapy

Psychotherapy, particularly cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), is an essential component of the management of adolescent depression. These evidence-based therapies have been shown to be effective in reducing depressive symptoms and improving overall functioning in this population.

CBT focuses on identifying and modifying negative thought patterns and behaviors that contribute to depression, while IPT addresses interpersonal issues and relationship difficulties that may be contributing to the depressive episode. Both therapies typically involve weekly 45-60 minute sessions over the course of 12-16 weeks.

In cases where the patient is unable or unwilling to engage in individual psychotherapy, family-based interventions, such as family-focused therapy or multi-family group therapy, may be considered. These approaches aim to improve communication, problem-solving, and coping skills within the family unit, which can in turn support the adolescent's recovery.

## Monitoring and Follow-up

Adolescents with depression should be closely monitored throughout the course of treatment. This includes regular assessment of depressive symptoms using the PHQ-A or a similar validated tool, as well as monitoring for the development of adverse effects related to medication therapy.

Patients should be seen for follow-up visits at least every 4-6 weeks during the initial phase of treatment, with the frequency of visits gradually decreasing as the patient's symptoms improve. During these visits, the clinician should assess the patient's progress, adjust medication dosages as needed, and provide ongoing support and psychoeducation.

In cases where the patient's symptoms do not improve or worsen despite appropriate treatment, the clinician should consider the need for more intensive interventions, such as referral to a mental health specialist, hospitalization, or the addition of adjunctive therapies (e.g., transcranial magnetic stimulation, ketamine infusion).

## Contraindications and Precautions

The use of SSRI antidepressants in adolescents is associated with an increased risk of suicidal thoughts and behaviors, particularly during the initial weeks of treatment. Clinicians should closely monitor patients for the emergence or worsening of suicidal ideation and provide appropriate interventions as needed.

Certain medical conditions and medications may also contraindicate or require special precautions when prescribing antidepressants to adolescents. For example, the use of SSRIs is generally contraindicated in patients with a history of bipolar disorder, as these medications may precipitate manic episodes. Additionally, the concomitant use of SSRIs and nonsteroidal anti-inflammatory drugs (NSAIDs) or anticoagulants may increase the risk of bleeding.

Clinicians should also be aware of the potential for drug interactions between antidepressants and other medications commonly used in the adolescent population, such as oral contraceptives, stimulants, and antiseizure drugs. Careful consideration of these factors is essential to ensure the safe and effective management of depression in this patient population.