PSYCHIATRY / DEPRESSION : Youths Found Much Slower at Recovering
Adolescents with clinical depression require much more time to recover than adults with the disorder, according to a new study from UCLA.
Two months after being hospitalized for treatment of clinical depression, the chances for recovery among teens was only one-tenth the rate commonly seen in adult patients: 3.5% compared to 38%, according to the study in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Fewer than one-third of the adolescents recovered by five months. And the researchers added that through seven months, the adolescent recovery rate remained “significantly less” than that reported in adults.
The surprising findings cast doubt on whether the standard, and highly successful, treatments for depression in adults work as well for adolescents, said Michael Strober, professor of psychiatry and biobehavioral sciences at the UCLA School of Medicine. But at the same time, it confirms that adolescents do indeed experience true depression.
“The irony is that the concept of clinical depression in young people was disputed in psychiatry until very recently. Now, as we accrue more scientific information, it appears as though this condition not only exists but it is unusually pernicious in young people,” Strober says.
The study is a two-year follow-up of a five-year study on 58 adolescents, ages 13 to 17, hospitalized for clinical depression.
According to Strober, the teen-agers were treated with the typical regimen used for adults: individual, family and group therapy as well as antidepressant drugs.
This treatment regimen works well for 80% to 90% of adults with clinical depression, studies indicate. And by the two-year mark, 90% of the teen-agers in the UCLA study had recovered. But the “painstakingly slow” recovery time of the teen-agers suggests that other avenues of treatment may need to be explored, Strober said.
It could be that the onset of clinical depression in childhood or adolescence is a more severe disorder and perhaps has stronger genetic influences than adult-onset depression, he added. Previous studies have indicated that teen-agers with clinical depression are more likely than adults to have a strong familial tendency toward the disease.
The unique biological factors surrounding puberty could also complicate depression, Strober said.
“The biology of adolescence may influence the manner in which young people respond to antidepressant drugs,” he said. “They may be rendered more resistant in some way, (even though) we know they are very effective in adults.”
Recovery from the illness might also be slowed because adolescence is a time when individuals are normally more emotional and self-conscious, Strober said. Clinical depression is different from occasional feelings of sadness in that the individual suffers from a prolonged period of feeling hopeless and helpless. The disorder is characterized by social withdrawal, fatigue, impaired social interactions, brooding, ruminations about problems and the inability to feel pleasure. Changes in appetite and sleeping patterns are also symptoms of depression in adults but may be less pronounced in depressed teen-agers.
In adolescents, Strober says: “It may be that . . . the effect is even more dramatic and psychologically impairing because it interrupts that important developmental process.”
The drawbacks of the study, researchers note, are the relatively small sample size as well as the fact that the adolescents were referred to a university medical center, which may imply that these youths were more acutely ill than adolescents referred to community-based or outpatient settings.
Nevertheless, experts praised the research for raising important new questions about adolescent mental health.
“The child-adolescent psychiatry area has lagged behind the adult area in research,” said Dr. Frederick K. Goodwin, director of the National Institute of Mental Health. “It’s important to have good, descriptive research on the way child and adolescent depression is experienced.”
If treatment of adolescents is so protracted, future research should address how depressed youths can be identified and referred for treatment sooner, Goodwin said.
“If those kids were caught early, would treatment have been more effective? That kind of research is lacking,” he said.
Strober and his colleagues also found that 18 of the adolescents experienced psychotic episodes characterized by hallucinations and delusions. Among those teen-agers, 28% went on to develop manic depression after two years, an illness marked by periods of severe depression alternating with euphoria and hyperactivity.
Moreover, a five-year follow-up of the teen-agers (as yet unpublished) shows half of the youths with psychosis went on to develop manic depression compared to 10% of the teens who did not exhibit psychotic symptoms initially, Strober said. Thus, psychotic episodes in depressed teens appear to indicate a high risk for later development of manic depression and might dictate early treatment for the disorder.
