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Opportunities and Challenges in Treating Adolescents and Young Adults With Major Depressive Disorder

Opportunities and Challenges in Treating Adolescents and Young Adults With Major Depressive Disorder

Description of COPE for teens and for adults/college studentsTable 1
The COPE 3 session topicsTable 2

With each national tragedy that involves a young person with symptoms of a mental health disorder, there is a call for increased access to mental health care for all youths. It is estimated that only 25% of children and adolescents who need treatment for depression receive it.1 There are incredible opportunities to intervene and change the trajectory of young people’s physical and mental health as well as their social well-being.

The youths discussed in this article span 2 developmental stages: adolescence and young adulthood. Youths aged 12 through 18 years make up the adolescent population; young adults aged 18 through 24 years, the ages of many college students, make up another developmental group with distinct mental health needs. According to the Substance Abuse and Mental Health Services Administration, 8.5% of adolescents experience a major depressive episode. Nearly half of the adolescents who have major depression (48.3%) report that it severely impairs their ability to function in at least 1 of 4 major areas of their everyday lives (home life, school/work, family relationships, social life).2,3

The prevalence of MDD in college-age youths is thought to be 8.7%, which is higher than in any other adult age-group.2,3 Depression in young adults is associated with an increased risk of substance abuse, unemployment, early pregnancy, and educational underachievement. Suicide, the most serious risk of depression, is the third leading cause of death in 14- to 24-year-olds and the second leading cause of death among college students.4

According to the Institute of Medicine, the onset of half of all mental health disorders is by age 14.5 Early interventions may mitigate the progression to more serious and persistent mental health concerns. Depression responds well to early intervention and treatment, and findings indicate that early treatment significantly decreases the number and severity of recurrent depressive episodes, which have a reoccurrence rate of approximately 60% to 70%.6

The 2009 report, Adolescent Health Services: Missing Opportunities, from the Institute of Medicine and National Research Council, states:

Adolescence is a period when patterns of health promoting or health damaging behaviors are established that will have a substantial influence on health status during adulthood, affecting rates of acute and chronic disease and life expectancy. Identification and treatment of the acute effects of health damaging behaviors provides an opportunity to counsel and educate adolescents about the lifelong benefits of establishing a healthy lifestyle.5(pxii)

Evidence-based interventions for depressed youths

Because adolescents and young adults are typically healthy and do not routinely have much contact with mental health care providers, primary care physicians are encouraged to follow the US Preventive Services Task Force Recommendation to screen adolescents and young adults for depression.7 Many young people do not know that their irritability, anger, sadness, and feelings of gloom may be symptoms of a treatable medical illness. Education about depression as a treatable illness with symptoms that respond to active treatment should be presented in academic programs at all levels.

Findings from studies indicate that there are very effective treatments for depression in youths, including cognitive-behavioral therapy (CBT), interpersonal psychotherapy, and antidepressant medication.8 CBT may provide protective factors for suicide and, in combination with an SSRI, provides the fastest- and longest-acting therapeutic effects.9,10 Psychiatric guidelines recommend that for optimal patient outcomes, psychotherapy and medication management (when indicated) need to occur simultaneously.11,12

Recent research, including systematic reviews and meta-analyses, supports CBT as an effective first-line treatment of depression in youths and also as an effective adjunct to medication in the treatment of MDD.13-16 Although CBT is well established as an effective treatment of depression, affected youths do not routinely receive it because of the shortage of mental health clinicians. To increase access to evidence-based CBT, the Creating Opportunities for Personal Empowerment (COPE) program was created. This is a 7-session manualized intervention based on CBT that can be delivered by a variety of trained health care clinicians and teachers.

What new information does this article provide?

At every visit with adolescents and young adults, there is an opportunity to intervene and change the trajectory of young people’s physical and mental health by promoting healthy lifestyle behaviors and healthy decision making, providing guidance about health-damaging and risky behaviors, and presenting coping skills using an evidence-based cognitive-behavioral approach.

What are the implications for psychiatric practice?

A cognitive-behavioral skills-building program such as COPE can augment medication management and provide effective evidence-based treatment for adolescents and young adults with MDD.

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