November 8, 2010

One in two depressed teens prone to recurrence after recovery

Research conducted at the Johns Hopkins Children’s Center and elsewhere shows that regardless of the type of treatment they get, nearly half of severely depressed teens who recover from a depressive episode are likely to slip back into depression within two to three years.

The findings of the multicenter NIH-funded study, which appears in the November issue of JAMA-Archives of General Psychiatry, show that nearly all (96 percent) of the 196 teenagers in the research group either improved or fully recovered after an initial depressive episode, but that 47 percent of them had one or more subsequent depressive episodes in an average of two years.
Much to the investigators’ surprise, they said, 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 as likely to suffer subsequent depressive episodes (49 percent of them did) as those who received either treatment alone (46 percent).

Two potent predictors of recurrence did emerge: being female and showing no response to treatment at all. For reasons that are not clearly understood, the researchers said, 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.

The findings highlight a need for long-term follow-up and rigorous monitoring of symptoms among depressed teens, even when they seem to be on the mend, the investigators said.
“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,” said researcher Golda Ginsburg, a psychologist at the Johns Hopkins Children’s Center and an 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 said.

Because nearly all teenagers recovered within two years of starting treatment, the results are far from discouraging, the researchers said, indicating that while not long-lasting, the therapy is highly effective in the short term. But the findings, they said, hint at 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, a combination of the two or placebo. At three months, teens receiving the combination treatment had the best response, but after nine months and after one year, the three treatments resulted in similar outcomes. Three months into the original study, those receiving placebo got the treatment of their choice.

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

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.

Institutions participating in the study in addition to Johns Hopkins and Duke were the Oregon Research Institute, University of Nebraska Medical Center, 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.