Follow up will be key when it comes to managing anxiety and depression in young people, Elizabeth Tracey reports
Identifying depression in young people is important, and now that a federal task force has recommended screening all youth 12 to 18 years of age, it should also be identified more readily. Yet Karen Swartz, a psychiatrist at Johns Hopkins, has a few concerns.
Swartz: The challenge with antidepressants is they take weeks and weeks and weeks to work. So someone has to be really knowledgeable and have the time to meet regularly and to continue doing education. I know you’re not feeling better yet but stick with it. I wouldn’t expect you necessarily to be feeling better yet, we have to give it more time. My colleagues in primary care don’t have that time. Primary care’s doing to have to be a part of the answer but I think we’re going to have to think about how we work more collaboratively with our colleagues in primary care, pediatrics, ob-gyn to get better care in these primary care settings. :33
Swartz encourages anyone with a positive screening test for depression to seek a mental health professional for confirmation and follow up. At Johns Hopkins, I’m Elizabeth Tracey.
Who will be screening young people for anxiety and depression? Elizabeth Tracey reports
Young people should be screened for anxiety and depression, a federal task force has recommended, and that means primary care physicians will have yet one more task to add to their list when it comes to providing the best care. Johns Hopkins psychiatrist Karen Swartz says there are pluses and minuses to this strategy.
Swartz: The whole idea that we’re now going to ask primary care doctors to add something else, that’s it’s own worry. The good news about the primary care doctors being involved the pediatricians being involved is that that’s where people are going. Most people have a relationship there, they don’t have a psychiatrist or a therapist. So that could be good. The problem is we’re asking them to do a lot, and they don’t really have time to do that next step. There’s also concerning data about what the quality of treatment is in primary care settings. :31
Swartz says any positive screen should be followed up with confirmation by a mental health professional. At Johns Hopkins, I’m Elizabeth Tracey.
A positive screening test for anxiety and depression in a young person needs confirmation, Elizabeth Tracey reports
If a young person is thought to have depression following a positive screening test, as is now recommended by a federal task force, one danger may be that they begin treatment without more carefully and thoroughly confirming the condition. That’s according to Karen Swartz, a psychiatrist at Johns Hopkins.
Swartz: The screens often will identify someone is maybe having it, but when they’re carefully examined they don’t. and so what I don’t want is a whole group of young people screened, not properly examined, and then started on treatment which they don’t need. What I don’t want is someone who right now is disappointed or distressed, they’ve had a bad breakup, they’re doing poorly in school, and then they take an antidepressant because someone has told them they screen for depression, it does no good because they don’t have depression, and then maybe later in their life, when they are facing a real depression that they say that doesn’t work, treatment doesn’t work. :35
Confirmation is key, Swartz says. At Johns Hopkins, I’m Elizabeth Tracey.
Will young people be adequately screened for depression and anxiety? Elizabeth Tracey reports
The United States Preventive Services Task Force recently recommended screening US youth for anxiety and depression. Karen Swartz, an expert in these illnesses in young people, says screening isn’t just a matter of asking a few questions.
Swartz: What I worry about with screening is they’ll do, usually you have a couple of questions and if you’re positive what should happen is there is a proper evaluation, someone really takes time to ask about the symptoms in enough detail to differentiate I’m stressed versus I have a real anxiety disorder. Or a serious problem with anxiety, or I’m disappointed or demoralized or frustrated versus I have the kind of depression that’s a medical illness. Previous studies have shown that there are a number of false positives with these screens. :33
Swartz says screening merely raises the suspicion that a problem might exist, and this must be confirmed with a much more thorough evaluation by someone with expertise in this area. At Johns Hopkins, I’m Elizabeth Tracey.
New guidelines recommend screening young people for depression and anxiety, Elizabeth Tracey reports
If you’re eight to eighteen years of age, a federal government task force now recommends you be screened for anxiety, and if you’re twelve to 18, for depression. Psychiatrist Karen Swartz at Johns Hopkins says this is likely a good move.
Swartz: Having more people thinking about depression and anxiety in kids is wonderful. There’s this idea that it’s throughout the lifespan so we have to screen adults, which we’ve been doing for a while but we also need to do the children. That’s great. The problem with screening is that screening is not making a diagnosis. Recently, especially after Covid, there are incredibly high rates of depressive symptoms and anxiety symptoms. One meta-analysis estimated that 25% of those under 18 had depressive symptoms and about 20% had anxiety symptoms. :32
Swartz says she isn’t sure if the pandemic can be blamed for the seemingly large uptick we’re seeing in anxiety and depression among young people, but it sure hasn’t helped. She’s hoping screening will. At Johns Hopkins, I’m Elizabeth Tracey.
If cell free DNA is associated with dementia risk, would removing it help? Elizabeth Tracey reports
Higher levels of DNA found circulating in the blood of older people were associated with a higher risk for dementia and frailty, a Johns Hopkins study shows. Peter Abadir, a geriatrics expert at Johns Hopkins and one author of the study, says the idea of simply removing this DNA from the blood may not decrease someone’s risk.
Adadir: I want to think about it more like fever. Yes, you can give Tylenol and remove the fever but there is an infection inside that’s driving something that we don’t know about. Even though people think of aging as a universal phenomenon that it happens to everybody, there is this group of older adults that we used to think this is part of normal aging. It’s okay to be forgetful as you age. It’s okay to fall as you age. Through research we’re starting to recognize that there is something abnormal about this selective group of patients that knowing early on can help us focus our resources. :34
At Johns Hopkins, I’m Elizabeth Tracey.