Managing and preventing depression in adolescents

#### Summary points Depressive disorder affects 1-6% of adolescents each year worldwide,1 2 and early onset heralds a more severe and persistent illness in adult life.3 Effective treatment is available, but best treatment practice is controversial because of concerns about the use of antidepressants in young people and inconsistencies in evidence. This review provides guidance for non-specialists on the assessment and management of adolescent unipolar depression and considers emerging evidence on prevention strategies. #### Sources and selection criteria We searched for papers published between 1990 and 2009 using key index terms (adolescent depression, treatment, and prevention) on PubMed (Medline and life science journals). In addition, we consulted the Institute of Medicine report “Preventing mental, emotional and behavioral disorders among young people: progress and possibilities” (published by National Academies Press 2009), NICE guidelines on adolescent depression, Cochrane systematic reviews, and BMJ Clinical Evidence . This was supplemented by reviews and our own knowledge. Evidence from prospective community studies suggests that rates of underdiagnosis and undertreatment of depression are higher in adolescents than in adults.4 Large scale, longitudinal population based and clinical cohort studies have consistently shown that rates of depression rise sharply after puberty, especially in girls, with immediate and long term risks.5 6 Clinical depression …