There are some cases in which depressed or anxious teens, who have been appropriately diagnosed and who are receiving treatment, don’t respond to treatment and are not improving.
For instance, a 17-year-old girl has been diagnosed with Major Depression and has been taking SSRI medication as well as attending psychotherapy. However, her symptoms have not improved despite the use of treatment that has been consistently effective, also known as evidence-based treatment. Treatment Resistant Depression is depression that does not respond to the adequate does of evidence based treatment.
Typically, when medication is used to treat teen depression, there is a 50% reduction in symptoms within 8 to 12 weeks. Approximately 60% of teens show a significant clinical response by 12 weeks and remission by 24 weeks. However, 40% of those who receive evidence-based treatment for teen depression are considered to be treatment resistant.
Treatment that is considered to be evidence based for teen depression includes the use of medication such as selective serotonin re-uptake inhibitors, also known as SSRI’s. SSRI’s increase the levels of serotonin, which can ease depressive symptoms and they have fewer and milder symptoms than other anti-depressants. In addition to medication is the use of psychotherapy, particularly Cognitive Behavioral Therapy (CBT).
CBT identifies negative and distorted thinking patterns. This successful form of therapy emphasizes the link between thoughts, feelings, and behavior, and more importantly, it attempts to identify the way that certain thoughts contribute to the unique problems of an adolescent’s life.
Interpersonal Therapy used with medication is also seen as evidenced based and has shown a faster rate of response than medication used with CBT. Interpersonal Therapy is a form of therapy that invites teens to regain control of their mood and functioning by exploring in more detail the nature of his or her relationships. IPT is based upon the ideas that regardless of genetics, depression develops within the context of relationships.
However, when a teen does not respond to these evidenced based treatments, sadly, depression can become chronic. As treatment continues to be ineffective, this can worsen symptoms and undermine any hope that a teen has. There are some factors that seem to consistently contribute to chronic teen depression and treatment resistance. They are:
- Severity of depression
- Co-occurring disorders, especially substance use
- Non-adherence to treatment
- Low blood concentration of the antidepressant
- History of abuse
- Parental depression
- Bullying at school
If you’re seeking other forms of treatment for your teen, there are some options. The first is a thorough examination of factors that might be contributing to the treatment resistance. For example, issues that might be explored in detail include quality of sleep, other psychological issues, and health factors. Treatment might be augmented, giving remission another chance.
It is known within the mental health field that teens with treatment resistant depression can eventually find remission from symptoms. Those who have not responded to traditional forms of treatment can undergo a treatment plan that uses a different type of antidepressant (such as SSNRI, TCA’s or MAOI’s) and a different form of therapy.
Although it is easy to lose hope when prognosis for treatment does not look good, as caregivers, you should know that depression is treatable even when at first treatment appears to be ineffective.
Reference:
Brent, David (Winter, 2018). UPMC Synergies. Treatment Resistant Depression in Adolescents. https://www.upmcphysicianresources.com/-/media/physicianresources/pdf-publications/psychiatry/synergies_winter_2018_07_final.pdf
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