Treating Depression and Co-occurring Disorders in Teens

Among adolescents seen in primary care with depression, a collaborative care intervention that included patient and parent engagement and education resulted in greater improvement in depressive symptoms according to a recent study. The overall rate of depression remission at 12 months was 50.4 percent for youth in the intervention group and 20.7 percent for youth in the control group.

Adolescent depression is a major pediatric public health concern. Approximately 11% of US adolescents experience an episode of depression by age 18. In addition, the World Health Organization ranks unipolar depression as the leading cause of “illness and disability” for 10- to 19-year-old youth worldwide, above common physical health problems like anemia and asthma.

The effects of depression on overall health are widespread and pervasive because of three principal concerns: depression is associated with serious mental health problems (e.g., suicidality); physical health problems (e.g., obesity); and adolescent high-risk behaviors (e.g., substance use).

Gloria M. Reeves, M.D., of the University of Maryland, School of Medicine, Baltimore, and Mark A. Riddle, M.D., of the Johns Hopkins University School of Medicine, Baltimore, the study authors agreed:

“Pediatric primary care clinicians have substantial potential to improve identification and treatment of adolescent depression. This study suggests that collaborative care treatment of adolescent depression can be structured to promote care that is evidence based, personalized, and effective.”

Yet the best available data indicates that approximately 40% of adolescent depression goes untreated.

Furthermore, the majority (55-74%) of adolescents entering substance use treatment also have psychiatric disorders, such as depression, ADHD and trauma-related problems. Unfortunately, these youth face poorer treatment outcomes (e.g., relapse), and their mental health issues are often not directly addressed. A new review proposes that the Adolescent Community Reinforcement Approach (A-CRA), which is a combination of cognitive-behavioral and family therapies, may be an ideal treatment method for this patient population.

Lead author Dr. Susan H. Godley claims:

“The Adolescent Community Reinforcement Approach (A-CRA) is a well-tested intervention for substance use disorders that has demonstrated potential as a treatment for co-morbid youth.”

The A-CRA offers substance use treatment providers a new option when caring for youth with co-occurring substance use disorders and mental health diagnoses.



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