In another needed response to the obesity epidemic affecting American youth (and the adults they will become), the National Heart, Lung and Blood Institute, part of the Federal National Institute of Health, has declared that pediatricians should be checking cholesterol when kids reach the age of 9 and before they are 11, and again when they reach 17 and before 21. The American Academy of Pediatrics, the national professional association for pediatricians, proceeded to endorse the institute's recommendation.
A popular business maxim is "What gets measured gets managed." When a child's blood sugar is 400 everyone jumps and insulin is on the way to prevent a diabetic coma. When a person's blood pressure is 180/120, child or adult, that number drives doctors, patients and families to get the pressure to a normal number, hoping to do so before that poor soul strokes out. From a public health standpoint, for a population of people of whatever age, when a specific measure becomes standard operating procedure in medical practice the sooner everyone, including doctors, nurses and patients, learns to medically -- or by lifestyle interventions -- manage the condition that threatens to undermine their wellbeing and abbreviate their time on earth.
Levels of cholesterol, blood pressure and sugar drive a doctor's practice because they are numbers in black and white in a medical record. They are inescapable reminders that work needs to be done. No one can rest, provider or patient, until that number is in "the normal range." That's why requiring cholesterol screening early and repeatedly is a good thing: Measuring cholesterol means we all are far more apt to manage it -- and reduce the risk of developing the heart and blood vessel diseases that will compromise the quality and duration of the lives of those affected.
In April of 2009, the US Preventative Task Force issued a report about screening for depression in children and adolescents, a disorder whose presence and impact on functioning is no less worrisome than high cholesterol. The Task Force studied "... primary care screening for Major Depressive Disorder among children and adolescents ages 7 to 18 years, including evaluating the accuracy of screening tests and the risks and benefits of treatment with psychotherapy and/or SSRIs."
It concluded that "... available data suggest that primary care feasible screening tools may be accurate in identifying depressed adolescents, and treatment can improve depression outcomes." But they stopped short by stating "... treating depressed youth with SSRIs [antidepressants] may be associated with a small increased risk of suicidality [note: not completed suicide but rather feeling suicidal] and therefore should only be considered if judicious clinical monitoring is possible."
Who would dare say that treatment proceed only if "clinical monitoring is possible" for youth with high sugar or blood pressure? Why is depression different?
It is possible to screen, monitor and manage depression when it is made a standard of medical care. It is already successfully going on in some exemplary pediatric (and adult) practices. It will be possible when depression is recognized as no less a problem than diabetes or high cholesterol. It will be possible when we stop treating mental problems as secondary citizens in the world of public health, which should happen, since the World Health Organization has alerted health ministries globally that by 2030 neuropsychiatric disorders* will be the leading contributor to the "global burden of disease," a measure of years of life lost as a result of living in less than full health and to early death.
Right now our car is checked with a battery of tests during a regular inspection. We can't drive our car (legally) without passing inspection by fixing what is wrong. Why would we drive our body without treating what ails it? Why not ensure that medical "inspection" (and treatment) includes depression than see lives break down because we neglected to detect and treat, early and effectively, so common and potentially disabling a disorder?
*Includes bipolar disorder, depression, schizophrenia, epilepsy, alcohol and drug use disorders, Alzheimer's and other dementias, Parkinson's, PTSD, OCD, and panic disorder.
The opinions expressed here are solely my own as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.
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