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 Three months after diagnosis, more than one third of the roughly
4,600 adolescents with depression in the study didn’t receive any
treatment at all, and more than two thirds didn’t get a follow-up
symptom evaluation with a specialist.
Less than half of the teens put on antidepressants received any
follow-up care during those first three months, the study also
found.
“If things don’t get better through appropriate treatment and
supports, things get worse,” said lead study author Briannon
O’Connor, who completed the research at New York University.
“Untreated, adolescents are likely to develop worsening symptoms of
both depression and other mental health problems, have increasing
difficulties in school performance, withdraw from family and
friends, and continue to have difficulties into adulthood,”
O’Connor, who now works with Coordinated Care Services Inc of
Rochester, New York, said by email.
Major depression is a chronic, disabling condition that affects more
than one in 10 teens, with as many as one in four adolescents
experiencing at least mild symptoms, O’Connor and colleagues report
in the journal JAMA Pediatrics. Generally, they do better the sooner
depression is caught and treated.
To see how often depressed teens do get timely treatment,
researchers reviewed electronic medical records from three large
healthcare systems and analyzed how many services patients received
in the first three months after the initial diagnosis.
On average, the teens were around 16 years old and most were girls.
Among about 1,000 youth diagnosed with major depression, 79 percent
started treatment within that three-month window, the study found.
But overall, 36 percent received no treatment, 68 percent lacked any
follow-up assessment and 19 percent failed to receive any follow-up
care during that time.
One limitation of the study is that the analysis of electronic
medical records may not have captured follow-up care by phone or
treatment that teens received outside of the health system where
they were initially diagnosed, the authors note. There was also
substantial variation in follow-up care rates in the different
health systems in the study.
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It’s possible that a “watch-and wait” approach might be appropriate
for some teens with fewer or milder symptoms, noted Dr. Megan
Moreno, a specialist in adolescent medicine at the University of
Washington and Seattle Children’s Research Institute who wasn’t
involved in the study. Some youth might also benefit from therapy
without added medication, she said.
“For teens with more serious symptoms, the gold standard treatment
is to start both therapy and anti-depressant medication right away,”
Moreno said by email. “Ongoing monitoring of symptoms is critical to
determine whether escalation or reduction in treatment is needed.”
While it can be challenging for parents to distinguish depression
from the periodic mood swings that are a hallmark of the teenage
years, certain behaviors can signal that it’s time to seek help,
Moreno added.
“In general, teens do go through times of moodiness and may have
episodes in which they withdraw from parents,” Moreno said.
“However, teens who withdraw from their entire social scene,
including parents, peers, and school may have something more serious
going on and may benefit from screening.”
SOURCE: http://bit.ly/1m8GArE JAMA Pediatrics, online February 1,
2016.
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