1. Gary R. Maslow, MD, MPH* 2. Kathleen Dunlap, MD, MPH† 3. Richard J. Chung, MD‡ 1. *Department of Psychiatry and Behavioral Sciences, Department of Pediatrics, Duke University School of Medicine, Durham, NC. 2. †Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC. 3. ‡Adolescent Medicine, Duke University Medical Center, Departments of Pediatrics and Medicine, Duke University School of Medicine, Durham, NC. Despite national recommendations, screening for adolescent depression is generally uncommon and is typically characterized by regional and racial/ethnic disparities. This variability in practice may leave some adolescents disproportionately vulnerable to untreated depression. Further education about depression in general and specifically regarding screening may help address such disparities. After completing this article, readers should be able to: 1. Describe the diagnostic criteria and initial assessment of depression. 2. Outline screening and management strategies for depression. 3. Discuss risk factors for and presentations of suicidal thoughts and behaviors. 4. Determine the acute management and secondary prevention of suicidality. Depression is underrecognized and undertreated in adolescents, with close to 75% of depressed adolescents not receiving treatment. Untreated depression in adolescence is associated with various adverse adult outcomes, including lower educational attainment and poorer physical health. Beyond the suffering and impaired functioning that depressed adolescents experience as well as the potential for future negative outcomes, the reality is that some affected adolescents commit suicide, further heightening the need for proactive assessment and treatment. Given the persistent shortage of mental health clinicians in the United States, significant emphasis has been placed on increasing the role of pediatricians in addressing this burden. In fact, a key pediatric quality metric that has garnered interest in recent years is screening for adolescent depression in primary care settings. In addition, the American Academy of Pediatrics included recognition and initial management of depression in its 2009 policy statement on recommended mental health competencies in primary care. (1) Given that adolescents with depression often present initially in the primary care setting, pediatricians are …