Here's what to watch for.

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The number of teens needing mental health support has increased.

"That includes things like depression, anxiety, and one of the ones that I think we were a bit surprised about would be eating disorders," says Dr. Billings.

She says the pandemic created a challenging and confusing world for many teens.

"That's their time to start to be independent and start to exert some control over their own lives," she says. "And that was taken away in a way that we had never experienced before."

If you are concerned about your teen, don't hesitate to seek help.

"Whether it be that you feel they're depressed, or anxious, or maybe suffering from an eating disorder, reaching out to your health care provider is the great first step," Dr. Billings says.

Here's what to watch for:

• Changes in activity level.
• More sleep.
• Isolation.
• Personality changes.
• Eating habits.

"There are great ways that we can treat all mental health illnesses — depression, anxiety, eating disorders — but we must have that first step of connecting," Dr. Billing says.

Related posts:

• What to do when someone is suicidal
• Antidepressants for children and teens
• Mayo Clinic Minute: Know the difference between adult and teen depression

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

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ROCHESTER, Minn. ― Mayo Clinic researchers have taken the first step in using artificial intelligence (AI) to predict early outcomes with antidepressants in children and adolescents with major depressive disorder, in a study published in The Journal of Child Psychology and Psychiatry. This work resulted from a collaborative effort between the departments of Molecular Pharmacology and Experimental Therapeutics, and Psychiatry and Psychology, at Mayo Clinic, with support from Mayo Clinic's Center for Individualized Medicine.

"This preliminary work suggests that AI has promise for assisting clinical decisions by informing physicians on the selection, use and dosing of antidepressants for children and adolescents with major depressive disorder," says Paul Croarkin, D.O., a Mayo Clinic psychiatrist and senior author of the study. "We saw improved predictions of treatment outcomes in samples of children and adolescents across two classes of antidepressants."

In the study, researchers identified variation in six depressive symptoms: difficulty having fun, social withdrawal, excessive fatigue, irritability, low self-esteem and depressed feelings.

They assessed these symptoms with the Children's Depression Rating Scale-Revised to predict outcomes to 10 to 12 weeks of antidepressant pharmacotherapy:

• The six symptoms predicted 10- to 12-week outcomes at four to six weeks in fluoxetine testing datasets, with an average accuracy of 73%.
• The same six symptoms predicted 10- to 12-week outcomes at four to six weeks in duloxetine testing datasets, with an average accuracy of 76%.
• In placebo-treated patients, predicting response and remission accuracy was significantly lower than for antidepressants at 67%.

These outcomes show the potential of AI and patient data to ensure children and adolescents receive treatment that has the highest likelihood of delivering therapeutic benefits with minimized side effects, explains Arjun Athreya, Ph.D., a Mayo Clinic researcher and lead author of the study.

"We designed the algorithm to mimic a clinician's logic of treatment management at an interim time point based on their estimated guess of whether a patient will likely or not benefit from pharmacotherapy at the current dose," says Dr. Athreya. "Hence, it was essential for me as a computer engineer to embed and observe the practice closely to not only understand the needs of the patient, but also how AI can be consumed and useful to the clinician to benefit the patient."

Next steps

The research findings are a foundation for future work incorporating physiological information, brain-based measures and pharmacogenomic data for precision medicine approaches in treating youth with depression. This will improve the care of young patients with depression, and help clinicians initiate and dose antidepressants in patients who benefit most.

"Technological advances are understudied tools that could enhance treatment approaches," says Liewei Wang, M.D., Ph.D., the Bernard and Edith Waterman Director of the Pharmacogenomics Program and Director of the Center for Individualized Medicine at the Mayo Clinic. "Predicting outcomes in children and adolescents treated for depression is critical in managing what could become a lifelong disease burden."

Acknowledgments

This work was supported by Mayo Clinic Foundation for Medical Education and Research; Mayo Clinic Center for Individualized Medicine; the National Science Foundation under award No. 2041339; and the National Institute of Mental Health under awards R01MH113700, R01MH124655 and R01AA027486. The content is solely the authors' responsibility and does not necessarily represent the official views of the funding agencies. The authors have declared no competing or potential conflicts of interest.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Colette Gallagher, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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ANSWER: Major depression is common. It’s estimated that up to 8 percent of teens have experienced depression in the past year. Untreated depression may place a teen at risk for recurrent depressive episodes or increase their risk of suicide. The risk factors for depression vary and include a family history of depression, age (a bit more common in older kids), and sex (more common in girls than boys). That said, it’s important to understand that depression can happen in teens who don’t have any of the typical risk factors.

It’s standard practice for health care providers to screen for depression in all teens starting at age 12. The questions and answers can give a health care provider insight about whether a teen may be at risk for depression. They also can spark conversation about a teen’s thoughts, feelings and behaviors. It’s useful to repeat the questionnaire annually throughout the teen years so a health care provider can watch for changes that could indicate an increased risk for depression.

The form that’s often used to screen for depression in teens is a patient health questionnaire called the PHQ-9 M. The “M” stands for “modified” because the questionnaire has been customized to be suitable for teens. It’s short, with only nine questions, and takes less than five minutes to complete. It addresses topics such as how a teen is feeling, interest in activities, sleeping and eating patterns, concentration, and energy and activity levels. It also asks if a teen has had thoughts of hurting himself or herself.

Answers are given on a scale of 0 to 3 to identify how often in the previous two weeks the teen has had each of the symptoms listed. The questionnaire then asks how difficult the problems identified on the form have made daily life. The answers are scored, and the total score is placed on a continuum of depression severity that runs from no depression at the low end to severe depression at the high end. During the same visit, the provider and the teen talk about the answers and what the total score means.

The PHQ-9 M is a useful tool for uncovering important issues and concerns that should be addressed and that otherwise may not come up during a teen’s well-child visit, such as feeling down, feelings of failure or thoughts of suicide. It also gives a health care provider the opportunity to probe further and find out more.

For example, if a teen answers “several days” to the question of how often he or she is “feeling bad about yourself — or feeling that you are a failure, or that you have let yourself or your family down,” that will prompt follow-up questions from the health care provider. The two can discuss what’s been going on in the teen’s life to bring on those feelings, and if it may signal a larger problem.

If the score on the questionnaire indicates depression, the health care provider may refer the teen to a mental health specialist or recommend other follow-up treatment. It’s important to note that the form is designed to show if a teen may be at an increased risk for depression or suicide. It is not intended as a tool to diagnose depression, and it can’t be used in place of a thorough evaluation with a health care provider.

Screening all teens for depression is important because depression is a serious mental health problem that requires treatment. In many cases, depression symptoms can get worse or lead to other concerns if left untreated. The sooner depression is identified, the sooner it can be addressed. For most teens with depression, treatment such as medication and psychological counseling can effectively ease symptoms and help them feel better. — Dr. Elizabeth Cozine, Family Medicine, Mayo Clinic, Rochester, Minnesota

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According to The North American Menopause Society (NAMS), up to 45 percent of postmenopausal women find sex painful, but fewer than a quarter of those women seek treatment. Part of the reason women stay quiet might just be the name used to describe the condition — vaginal atrophy. To combat the stigma, the NAMS and the International Society for the Study of Women's Sexual Health have introduced a new medical term — genitourinary syndrome of menopause (GSM) — in the hope that it will encourage more women to seek treatment. On the next Mayo Clinic Radio program, women's health expert Dr. Stephanie Faubion will discuss GSM and other menopause-related problems. Also on the program, care coordinator nurse RoxAnne Brennan will explain the EMERALD program for treating adolescent depression. And, a Mayo Clinic patient shares his heart transplant story.

Listen to the program on Saturday, Aug. 13, at 9:05 a.m. CDT, and follow #MayoClinicRadio.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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Listen to the program on Saturday, Aug. 13, at 9:05 a.m. CDT.

Miss the show?  Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Vaginal Atrophy / EMERALD Program / Heart Transplant Patient Story appeared first on Mayo Clinic News Network.