Many teens diagnosed with depression don't immediately receive needed follow-up care even when therapy is recommended or medication is prescribed, a U.S. study suggests.

Three months after diagnosis, more than one third of the roughly 4,600 adolescents with depression in the study didn't receive any treatment at all, and more than two thirds didn't get a follow-up symptom evaluation with a specialist.

Less than half of the teens put on antidepressants received any follow-up care during those first three months, the study also found.

"If things don't get better through appropriate treatment and supports, things get worse," said lead study author Briannon O'Connor, who completed the research at New York University.

"Untreated, adolescents are likely to develop worsening symptoms of both depression and other mental health problems, have increasing difficulties in school performance, withdraw from family and friends, and continue to have difficulties into adulthood," O'Connor, who now works with Coordinated Care Services Inc of Rochester, New York, said by email.

Major depression is a chronic, disabling condition that affects more than one in 10 teens, with as many as one in four adolescents experiencing at least mild symptoms, O'Connor and colleagues report in the journal JAMA Pediatrics. Generally, they do better the sooner depression is caught and treated.

To see how often depressed teens do get timely treatment, researchers reviewed electronic medical records from three large healthcare systems and analyzed how many services patients received in the first three months after the initial diagnosis.

On average, the teens were around 16 years old and most were girls.

Among about 1,000 youth diagnosed with major depression, 79 percent started treatment within that three-month window, the study found.

But overall, 36 percent received no treatment, 68 percent lacked any follow-up assessment and 19 percent failed to receive any follow-up care during that time.

One limitation of the study is that the analysis of electronic medical records may not have captured follow-up care by phone or treatment that teens received outside of the health system where they were initially diagnosed, the authors note. There was also substantial variation in follow-up care rates in the different health systems in the study.

It's possible that a "watch-and wait" approach might be appropriate for some teens with fewer or milder symptoms, noted Dr. Megan Moreno, a specialist in adolescent medicine at the University of Washington and Seattle Children's Research Institute who wasn't involved in the study. Some youth might also benefit from therapy without added medication, she said.

"For teens with more serious symptoms, the gold standard treatment is to start both therapy and anti-depressant medication right away," Moreno said by email. "Ongoing monitoring of symptoms is critical to determine whether escalation or reduction in treatment is needed."

While it can be challenging for parents to distinguish depression from the periodic mood swings that are a hallmark of the teenage years, certain behaviors can signal that it's time to seek help, Moreno added.

"In general, teens do go through times of moodiness and may have episodes in which they withdraw from parents," Moreno said. "However, teens who withdraw from their entire social scene, including parents, peers, and school may have something more serious going on and may benefit from screening."

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