Practice Guidelines

Depression in Adolescents: AAP Updates Guidelines on Diagnosis and Treatment


Key Points for Practice

• After a patient is diagnosed with mild depression, physicians should consider active support and monitoring for six to eight weeks before initiating treatment.

• Only treatments that have been proven effective for depression, such as cognitive behavior therapy and SSRIs, should be recommended.

• Even after symptom resolution, patients being treated for depression should be monitored monthly for six to 12 months and up to two years for those being treated for a recurrence

From the AFP Editors

Although depression is associated with short- and long-term morbidity in adolescents, only 50% are diagnosed before becoming adults, with many adolescents never receiving treatment. These updated recommendations from the American Academy of Pediatrics (AAP) aim to address the identification and diagnosis of all forms of depression in adolescents, defined in this guideline as those 10 to 21 years of age. Recommendations regarding treatment of major depressive disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), in this population also are provided.


Because of the high prevalence (20% by 20 years of age) and persistence of depression in adolescents and the importance of brain development in these patients, physicians should screen adolescents who are at least 12 years of age for depression annually via a formal self-report tool in an attempt to identify the condition early. Because evidence regarding the most effective initial screening tool is lacking, physicians should use what works best for their practices and patients. Identifying patients with risk factors for depression is important to allow for routine monitoring for a depressive disorder over time. These risk factors include a personal or family history of depression, bipolar disorder, suicide-related behavior, substance use, or other psychiatric illness; major psychosocial stressors, such as physical or sexual abuse; recurring somatic problems; and being in foster care or being adopted.


An assessment using diagnostic criteria from the DSM-5 or the International Classification of Diseases, 10th revision, and standardized depression tools should be

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



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Aug 15, 2019

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