Concussion is a common diagnosis in adolescents, particularly in those who play sports. Physical and cognitive rest is the mainstay of treatment. However, the guidelines for returning to full cognitive effort are more nebulous. This article examines the existing evidence on return-to-learn guidelines, and offers some ideas of school accommodations that can be made for students who have experienced a concussion. This article also reviews the situations in which it is recommended to seek guidance from a concussion specialist or sports medicine physician.

I recently had an adolescent patient who presented with a chief complaint of depression. He had classic symptoms of difficulty sleeping, dysthymia, and anhedonia (loss of interest in things that used to bring him joy). He was a very smart and self-aware 17-year-old, and was able to describe his symptoms easily. There were no concerns for manic episodes or psychosis, and he met diagnostic criteria for unipolar major depressive disorder. He denied suicidal ideation, and was already seeing a therapist weekly for the last several months. He had a strong family history of depression, with his father, aunts, and grandmother who also carried a diagnosis of depression. He presented with the support of his mother, asking about next steps, and specifically, pharmacotherapy. This patient is a perfect example of an adolescent who is a good candidate for initiation of antidepressant medication. Primary care pediatricians should feel comfortable with first-line agents for major depressive disorder in certain adolescents with depression, but many feel hesitant and rely on child and adolescent psychiatry colleagues for prescriptions. [ Pediatr Ann . 2015;44(11):466–468,470.]