How family doctors can help kids and teens fight depression and anxiety

Pediatricians and family doctors have a vital role to play in the detection and treatment of depression and anxiety in children and teenagers, a national gathering of health-care providers at the Convention Center was told Wednesday.

“You’re on the front line,” said Theodora Pinnock, a developmental pediatrician and assistant professor at Meharry Medical College in Nashville. “A lot of kids are going to come your way who have issues with anxiety and depression. If we don’t help them, who will?”

Pinnock was part of a panel that addressed members of the National Medical Association on the final day of the organization’s 115th annual convention, held in Philadelphia. The association advocates for the interests of African American patients and health-care providers. Over 3,000 members were estimated to participate in the convention and scientific assembly.

Tami Benton, psychiatrist-in-chief with Children’s Hospital of Philadelphia, told the pediatric and family medicine gathering that about 40 percent of the health problems treated at the hospital have some behavioral health component. However, she said, only about a third of those who experience a depressive episode are likely to be diagnosed and treated.

Anxiety is also common. About a quarter of teens between 13 and 18 experience it, and the average onset is age 11, according to O’Nisha Lawrence, a child and adolescent psychiatrist at CHOP.

The panel stressed the importance of learning signs of common mental health problems so young patients can be diagnosed and treated, or referred for additional help if needed.

Benton said children and parents should both be interviewed. Doctors may have to look beyond the words youngsters use to describe how they’re feeling. Sometimes, according to Benton, a depressed child will talk about being bored, not depressed.

Or “you’ll hear irritability,” Benton said.

Sleep problems and difficulty concentrating are also common. They can be a result or a cause of emotional distress.

Benton noted that children can also be affected by lack of structure at home; basic, positive events like family dinners together often are not a part of modern family life, she said.

Additionally, Lawrence said excessive and unmonitored cellphone use can be detrimental to children’s emotional health and development.

“My heart stops when I see these 12-year-olds with cellphones,” Lawrence said.

If a child does show signs of depression, cognitive behavioral therapy can be a valuable treatment tool.

“We recognize changing your behavior may actually change the way you feel,” Benton said.

To treat severe depression, Benton said, medication, coupled with therapy, can be effective.

Lawrence suggested primary care doctors should stay involved in their young patients’ mental health care, even when a specialist is brought in.

“You can play such a big role in getting help for a child,” Lawrence said.

Some families may be reluctant to trust a mental health professional, and the family doctor can help on that front. This also protects families from feeling abandoned. If thoughts about self-harm or suicide are expressed, primary-care doctors should discuss them with the family and make a plan to minimize the possibility of harm.

“No kid should leave your office without a safety plan,” Benton said.