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Depressed Teens May Need Extra Support To Stick With Treatment

Say a pediatrician notices that one of her teenage patients is showing signs of depression. In most cases, the doctor will notify parents and prescribe an antidepressant or recommend a therapist.

The trouble is, many of those teens won't go to therapy or won't stick with it. And that's part of a bigger problem: Nearly two-thirds of adolescents who have had a major depressive episode don't get treatment, according to the Substance Abuse and Mental Health Services Administration.

Getting parents more involved is a way to start reversing that trend, according to a study published Tuesday in the Journal of the American Medical Association. And pairing depressed teens with a counselor or clinician who can help them follow through with treatment can help as well.

In a clinical trial, researchers from the University of Washington and Seattle Children's Hospital split a group of 100 teens who screened positive for depression into two categories. Half were referred to mental health specialists and had their screening results mailed to their parents.

The rest were treated with what doctors call a collaborative care model. These kids were paired with a depression care manager (a specially trained nurse, social worker or therapist) who worked with them and their parents to choose a therapist and make decisions about whether a psychiatric medication might help. The care manager also followed up with the teens every week or two, and called their parents every month.

After a year, only 27 percent of the teens who didn't get that extra coaching had enlisted in the recommended treatment, while 86 percent of the collaborative care group got treatment.

Dr. Laura Richardson, who led the study, says just the process of finding a therapist or psychiatrist can overwhelm teens and their parents. "We're asking them to go and access a system they've never navigated before," she says.

The care managers can help get the ball rolling, and also serve as mediators when teens and parents have different ideas about treatment, Richardson says. "In most cases, the teens really didn't want to go talk to somebody — they really would rather take a pill. And most commonly, the parents were opposed to that. Working through that sort of thing is really important for teens. They need to feel heard, and they need to feel supported."

The study's findings are in line with other research showing the collaborative care model works well for adults with mental disorders, says David Kolko, an adolescent psychologist and professor at the University of Pittsburgh.

"I think it shows great promise as a model," he says. "But I don't think it's an easy thing yet for us to implement." In general, the primary care system and the mental health care system are still separate in the United States, Kolko notes; primary care physicians don't get much training in mental health. Plus, most insurance companies have different reimbursement systems for mental and physical health.

The medical community's attitude about the best way to treat mental health problems also needs to change, Richardson says. The care manager the study employed cost about $1,400 per teen, she says. "When we compare that to what we pay for an MRI or any diagnostic testing, it's not that much."

"If I told you we could have a threefold improvement in cancer outcomes, people would jump on that," Richardson says. "I think we're a little more skeptical when it comes to mental health," she says.

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