Drugs, not therapy, the first line of treatment for troubled adolescents

THREE-QUARTERS of depressed adolescents are prescribed drugs before psychotherapy has been given a proper chance to work, and their progress on antidepressant medication is inadequately monitored, according to a study of 150 clients referred to a youth mental health service.

The University of Melbourne audit of treatment records from the Orygen Youth Health Clinic revealed doctors systematically recorded the severity of the depression they diagnosed in only half of cases – even though this is considered essential for determining what type of therapy is likely to work best, and for assessing later how well the person is responding to it.

The study, of patients aged 15 to 25, found that among those who were given antidepressant treatment and were not already taking the drugs when they were first seen by the specialist youth service, 75 per cent were prescribed the drugs within 42 days.

The study leader, Sarah Hetrick, said this suggested they were likely to have been given their first script before completing the four to six sessions of psychological therapy recommended as initial treatment in guidelines issued in Australia by the National Depression Initiative, beyondblue, and by international authorities.

Previous research had shown doctors were concerned some young people with severe depression needed to start drug treatment more quickly, said psychologist Dr Hetrick, whose research is published in the journal BMC Health Services Research. But even among these cases – likely to be most seriously affected – depression severity went undocumented in 20 per cent.

Fewer than half of the patients taking a drug had weekly face-to-face and phone contact with clinic staff during the first four weeks after starting it, despite advice that such patients should be ”carefully monitored”.

In a more positive finding, Prozac was the treatment prescribed overwhelmingly for those 18 or younger.

This was in line with government and medical recommendations, following evidence other antidepressants increased thoughts of suicide in some young people.

Dr Hetrick said the trends she had identified were likely to be repeated in other youth mental health clinics, and might result from a lack of staff capacity or doctors’ scepticism about the recommendations.

Article source: http://www.smh.com.au/national/health/drugs-not-therapy-the-first-line-of-treatment-for-troubled-adolescents-20120708-21pi3.html