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Teens with depression benefit from 'collaborative care'

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For teenagers with depression, finding and sticking with an effective treatment strategy can be an uphill battle. Their families often struggle to find a professional who can treat depression in adolescents, is accepting new patients and is covered by their insurance.

"Right now, we don't do a very good job of linking kids to treatment," said Dr. Laura Richardson, a professor of pediatrics at Seattle Children's Hospital and the University of Washington in Seattle.

But an idea called "collaborative care" — which increases communication between families and doctors — may help bridge that gap, said Richardson, who co-authored a new study detailing the findings, published today (Aug. 26) in the journal JAMA.

The researchers followed 101 teenagers with depression at Group Health Cooperative in Seattle. The teens were randomly assigned to receive either the usual care, meaning their doctors encouraged them to pursue treatment for their depression, or collaborative care, meaning that a depression care manager was assigned to their case, set up education sessions with the teens and their parents, and followed up with phone calls for a year.

After a year, the teenagers who had received collaborative care had significantly better outcomes than did those in the usual group, the study found. [10 Facts Every Parent Should Know About Their Teen's Brain]

"This is very convincing in terms of how it works," said Dr. Mark Riddle, a professor of psychiatry and pediatrics at the Johns Hopkins University School of Medicine in Baltimore who was not involved in the study. "It's cost-effective, [and] the families liked it OK. This, to me, is what I call the 'slam dunk.'"

Researchers have found effective ways to treat teenagers with depression — often with psychotherapy and antidepressant medication — but they are still searching for successful techniques that connect teens to these services, said Riddle, who wrote an opinion piece on the study for JAMA. Although more than 70 randomized clinical trials show that collaborative-care intervention can help adults with depression, only two collaborative-care studies have focused on teenagers suffering from the condition.

During the educational session, the care manager told the family about the available treatments for depression, including information about their effectiveness and side effects. Then, the care managers asked the teenagers and parents whether they preferred to be treated with psychotherapy, medication or both.

Then, the care manager jump-started the treatment. If the teenager wanted psychotherapy, the care manager set up the appointment. If the teenager asked for medication, the care manager would arrange for a doctor to write a prescription.

"The care manager's task was to monitor those kids over time," Richardson said. "Their job was to make sure these kids were getting what they needed."

Each of the four care managers involved in the study regularly called the teenagers to see how their treatments were going. If the treatment plan didn't appear to be helping after four to six weeks, the manager consulted with a team to formulate a new treatment strategy.

Sometimes, the teenagers didn't return phone calls, Richardson said. "When people are feeling depression, they aren't very motivated, and they have a lot on their plates," she said. "Having that person reaching out to them, saying, 'How are you doing?' I think makes a very big difference."

Over the year, the number of depressive symptoms — such as irritability, sleep and eating problems, and feelings of worthlessness — decreased more in the teens who received collaborative care than in the usual-care group, the study found.

The researchers also found that 68 percent of teenagers in the collaborative-care group experienced a 50 percent or more decrease in their symptoms of depression, while only 39 percent of the teens in the care-as-usual group felt that much of a drop in their symptoms by the end of the year.

Remission was also more common among the collaborative-care teenagers. About half reported that their depression went into remission, compared with about 21 percent of the teenagers in the typical group.

On average, the extra cost of collaborative care totaled about $1,400 a year per teenager, which is less than the cost of a single MRI, Richardson said. She and her colleagues are now studying ways to help implement the system in other medical centers.

"We really need to think about how we engage patients in care," she said. "I think we can do better."

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