Though concerns have been raised about giving antidepressants to teenagers, a study out Tuesday shows that boosting depressed teens’ access to well-researched therapies - whether medication or counseling - does improve their mental well-being.

The study evaluated a “quality improvement” program in which depressed adolescents’ routine primary care was bolstered with specialized mental health services.

Psychotherapists acted as “care managers,” and teenagers and their primary care doctors had the option of starting antidepressant treatment, cognitive-behavioral therapy or a combination of the two; they were also free to choose continued monitoring by a case manager or referral to other psychiatric care.

Researchers found that of the 418 13- to 21-year-olds in the study, those in the quality improvement program were more likely to opt for treatment and, 6 months later, generally showed fewer Depression symptoms and better quality of life.

The findings are published in the January 19th issue of the Journal of the American Medical Association.

Roughly 20 percent of children will suffer from “clinically significant” Depression by age 18, noted Dr. Joan Rosenbaum Asarnow, a professor of psychiatry and behavioral sciences at the University of California Los Angeles and the lead author of the study.

Yet there is a “high unmet need” when it comes to treating Depression - and other mental health problems - in children and teens, she told Reuters Health.

Though research has suggested that counseling and some antidepressants are effective for Depression in childhood and adolescence, these advances have so far made little difference in routine primary care, Asarnow and her colleagues note in their report.

Complicating the matter are concerns over the safety of antidepressant drugs for kids and teens. The U.S. Food and Drug Administration recently ordered the makers of all such drugs to include strong warnings that the medications may increase the risk of suicide or suicidal thoughts in some children.

The new study included depressed adolescents seen at five different primary care sites. They were randomly assigned to receive either the enhanced care of the quality improvement program or standard care over 6 months.

As part of the program, care managers helped primary care doctors evaluate and manage patients’ Depression; the care managers were also trained in standardized cognitive-behavioral therapy, or CBT - a form of counseling in which patients learn to identify and address their emotionally destructive thoughts and behaviors.

Overall, one-third of the adolescents in the program chose some form of treatment, twice as many as in the comparison group. The difference was due to higher rates of CBT or other talk therapy, as medication use was similar in the two groups, Asarnow’s team found.

The higher treatment rate translated into fewer Depression symptoms after 6 months, according to the researchers. For example, 31 percent of patients in the quality improvement program had severe Depression at the study’s end, versus 42 percent in the standard-care group.

Routine primary care, Asarnow said, provides a “window of opportunity” to improve the treatment of adolescent Depression. Part of the point of this program, she explained, was to strengthen the doctor-patient relationship so that the teens would be more likely to turn to health care providers in times of crisis.

Translating this program from the research setting to everyday care, according to Asarnow, will take, in part, a system for integrating case managers into primary care clinics. In addition, she noted, primary care doctors need more education about cognitive-behavioral therapy.

In this study, the researchers found, when teens and their parents had the options explained to them, they typically chose talk therapy over antidepressants, even though the former requires more effort.

SOURCE: Journal of the American Medical Association, January 19, 2005.