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Primary care physicians are the first line of health care, screening for conditions that would otherwise go untreated. This may be particularly true for teens that may be exhibiting mental health symptoms. Parents and teens may dismiss depression as normal teen angst, but a physician could spot the signs. However, a study discovered that pediatric primary care practitioners are reluctant to issue prescriptions to treat teen depression, even severe depression. 

Dr. Ana Radovic of Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, and her fellow researchers recruited 58 pediatric primary care practitioners, mostly doctors with some nurse practitioners. The participants were presented with two scenarios featuring 15-year-old girls that met depression criteria, one with moderate depression and the other with severe depression. Neither of the scenarios included suicidal behavior, the researchers told the participants.

The healthcare providers were asked to make an initial treatment recommendation, and were also asked about their knowledge of mental health, attitudes about treatment and their practice characteristics.

Only about one-quarter of the primary care physicians said that they would treat the patient with an antidepressant if they were diagnosed with moderate depression, as in the first vignette. About one-third said that they would treat the patient with severe depression.

Radovic says that adolescent depression is an undertreated public health problem due to an inadequate number of child psychiatrists. A primary care physician needs to be committed to treating mental health problems while collaborating with mental health professionals.

The current treatment recommendations for teens with moderate to severe depression include prescribing antidepressants used together or independently with cognitive-behavioral therapy to improve symptoms. The researchers note that antidepressants have been shown to be an effective treatment for depression, particularly in cases of severe depression.

Most of the participants in the study said that their preferred initial action would be to refer the patient to a child psychiatrist for medication management. This was true 60 percent of the time in the case of the moderate depression scenario, and 90 percent of the time when depression was considered severe.

The researchers report that while mental health consultation may be preferable when a teen is severely depressed, it is not necessary when the teen is diagnosed with moderate depression.

It’s important that teens be treated for moderate depression without the involvement of mental health specialists because the number of teens with depression is much greater than the capacity of mental health physicians to treat them.

The researchers discovered that when a primary care practitioner had access to mental health care providers on site they were five times more likely to recommend antidepressants for the patient. All of the participants were part of a large pediatric practice network that had access to mental health services.

Providers that scored higher on the measures of depression knowledge were 70 percent more likely to prescribe antidepressants. However, those that felt a higher level of personal burden in treating patients for mental health symptoms were less likely to recommend the use of antidepressants.

The researchers recommend that primary care practitioners be trained in prescribing antidepressants, as well as receive increased depression education.

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