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Kelly McGuire M.D., M.P.A.
Medical Director, Psychiatry
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Special Event May 18: Mental Well-Being for New Yorkers
On May 18, 2023, you are invited to join us for an educational webinar on mental well-being for New Yorkers that I am leading with Sarah Downs, WellSpark Health’s director of health programming and delivery. This webinar will include a clinical overview of common mental health conditions, a discussion on coping and supporting loved ones, actionable tips for improving mental well-being, and an opportunity to have your questions answered by our panelists. We are partnering with New York City Council Member Linda Lee, chair of the Committee on Mental Health, Disabilities, and Addiction, who will provide opening remarks.
The webinar is open to the public.
Mental Well-Being for New Yorkers
Thursday, May 18, 5 – 6 p.m.
Register here. You will receive a link to join the event after you register.
I look forward to an insightful session as we observe Mental Health Awareness Month not only in May, but year-round.
Attendees are advised that information provided during the webinar is for informational purposes only. It is not medical advice and should not be substituted for a health care provider’s guidance. Anyone with concerns about their health should contact their own health care provider. Information shared is not intended to imply that services or treatments described are covered benefits under any member’s plan.
Prescribing for Children and Adolescents With Depression
Hello colleagues,
I serve as the medical director of psychiatry for EmblemHealth and have specialized training in child and adolescent psychiatry. For my first MD Perspectives blog post, in honor of Mental Health Awareness Month, I would like to talk about treating childhood and adolescent depression.
Depression has been on the rise among children and adolescents even before the pandemic. Since the pandemic, the prevalence has worsened in the context of lockdowns, change of routine, missed family and community celebrations, social isolation, illness, the fear of illness, and the loss of loved ones. Today, teen suicide is a national crisis.
If you are a primary care provider (PCP), you serve a critical role in not only screening for depression, but also treating depression in children and adolescents. To help support PCPs in their treatment of depression in this population, I would like to share a resource I have found useful in my own practice — the clinical practice guidelines of the American Academy of Childhood and Adolescent Psychiatry (AACAP).*
AACAP states the following interventions have empirical support and expert consensus for the treatment of major depressive disorder in children and adolescents:
- Cognitive behavioral therapy (CBT).
- Interpersonal therapy (IPT).
- Selective serotonin reuptake inhibitors (SSRIs), except paroxetine/Paxil.
For mild presentations: AACAP recommends considering supportive interventions as a first-line treatment.
For moderate-to-severe presentations: AACAP recommends empirically validated psychotherapies (specifically CBT or IPT) and evidence-based SSRI medicines alone or in combination.
The only two SSRIs currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents are:
- Fluoxetine (for 8 years old and older).
- Escitalopram (for 12 years old and older).
The AACAP clinical practice guidelines state that SSRIs are generally well tolerated by children and adolescents. However, there is some risk for side effects** to occur. To minimize the chance of adverse effects, AACAP recommends starting a new SSRI at a subtherapeutic dose. Despite the low risk found, AACAP recommends closely monitoring for suicidality – especially in the first months of treatment and following dosage adjustments. This recommendation is also endorsed by the FDA.
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*The American Academy of Child and Adolescent Psychiatry (AACAP) 2022 Clinical Practice Guideline for Assessment and Treatment of Children and Adolescents with Major and Persistent Depressive Disorders.
**When side effects do occur, most present in the first few weeks of treatment and include, but are not limited to, dry mouth, nausea, diarrhea, heartburn, headache, somnolence, insomnia, dizziness, vivid dreams, changes in appetite, weight loss or gain, fatigue, nervousness, tremor, bruxism, and diaphoresis. Potentially serious adverse effects include, but are not limited to, suicidal thinking and behavior, behavioral activation/agitation, hypomania, mania, sexual dysfunction, seizures, abnormal bleeding, and serotonin syndrome. It is important to know that all SSRIs have a black box warning for suicidal thinking and behavior for individuals up to 24 years of age. The Clinical Practice Guidelines cites the pooled absolute rates for suicidal ideation across all antidepressant classes for youth with major depressive disorder in one analysis to be 3% for youth treated with an antidepressant and 2% for youth treated with a placebo.
We Are Here To Help
Resources to help support mental health awareness are available to you here:
EmblemHealth Behavioral Health | ConnectiCare Behavioral Health.
If a member needs help finding a behavioral health professional, please have them contact the following:
EmblemHealth members: Call Carelon (formerly Beacon Health Options) at 888-447-2526 (TTY: 711). A representative can help 24 hours a day, seven days a week.
ConnectiCare members: Call Optum at 888-946-4658 (TTY: 711). A representative can help 24 hours a day, seven days a week.
Neighborhood Care: EmblemHealth members can stop by any of our Neighborhood Care locations for community support. Visit emblemhealth.com/neighborhood.
