Teen depression likely to recur

DUKE / JOHNS HOPKINS (US) — Nearly half of teens who recover from severe depression are likely to slip back into depression within two to three years, regardless of the type of treatment they’ve received.

The study, in the November issue of JAMA-Archives of General Psychiatry, highlights a need for long-term follow-up and rigorous monitoring of symptoms among depressed teens—even when they seem to be on the mend.

“To ward off more bouts of depression and to recognize and treat them promptly if they do occur, parents, pediatricians, and mental health professionals should view childhood depression as a chronic condition marked by remissions and flare-ups,” says Golda Ginsburg, associate professor of psychiatry at the Johns Hopkins University School of Medicine.

Symptoms should be monitored carefully, and therapy frequency and medication dosage adjusted as needed in all teens diagnosed with depression, Ginsburg adds.

Depression, which affects an estimated 6 percent of teen girls in the United States and nearly 5 percent of boys, can lead to impaired school performance and social functioning, adult depression and suicide.

Nearly all (96 percent) of the 196 teenagers in the study either improved or fully recovered after an initial depressive episode, but 47 percent had one or more subsequent depressive episodes in an average of two years.

The type of treatment received made no difference in terms of recurrence. Indeed, teens treated with a combination of medication and cognitive behavioral therapy appeared just about as likely to suffer subsequent depressive episodes—49 percent of them did—as those who received either treatment alone. Forty-six percent of those patients had second episodes.

Two potent predictors of recurrence did emerge: being female and showing no response to treatment at all.

For reasons that are not clearly understood, girls were more likely to have repeated bouts of depression, with nearly 60 percent of them suffering subsequent depressive episodes after recovery, compared to 33 percent of the boys.

Teens who showed no improvement during treatment (37 out of 196) but who subsequently recovered were also more likely to have subsequent episodes of depression—67 percent did so—compared to 43 percent among those who responded to treatment either fully or in part.

Because nearly all teenagers recovered within two years of starting treatment, the results are far from discouraging, indicating that while not long-lasting, therapy is highly effective in the short term.

But the findings suggest the need to identify treatments that reduce recurrences and improve long-term recovery.

The new results are based on a three-and-a-half-year follow-up of 196 teens who participated in an earlier seminal study, published in JAMA in 2004, comparing outcomes among 439 teens with depression treated with medication, cognitive behavioral therapy (CBT), a combination of the two or with placebo.

At three months, teens receiving the combination treatment had the best response, but after nine months and one year, all three treatments resulted in similar outcomes. Three months into the original study, those receiving placebo got the treatment of their choice.

The research was funded by the National Institute of Mental Health.

John Curry of Duke University was the lead author on the paper. Elizabeth Kastelic of the Johns Hopkins Children’s Center was co-investigator.

Other participating institutions were the Oregon Research Institute, the University of Nebraska Medical Center, the University of Texas-Southwestern, Columbia University Medical Center, Cincinnati Children’s Medical Center, Case Western Reserve University, University of Oregon, and Children’s Hospital of Philadelphia.

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