Depression during adolescence can have significant negative effects on education, training, job prospects and independent living. Most adolescents recover completely from the initial episode. Greater severity, suicidal ideations, higher cortisol levels, comorbidity, earlier age of onset and parent reported behavioural problems predict longer time to recovery. Some of these factors also predict recurrence. Nearly half of those who experience depression during adolescence will have a recurrence. Of those who experienced a depressive episode,3-6% could be suffering from bipolar disorder.
Glenn A. Melvin Amanda L. Dudley , Michael S. Gordon , Sarah Ford John Taffe and Bruce J. Tonge report 3–9 year outcomes of a sample of depressed teenagers in Australia participating in a naturalistic follow-up study . The cohort was originally participating in RCTs (CBT). Diagnostic assessment was accompanied by physical and psychosocial health, interpersonal relationships, health service utilisation, education and employment outcome assessments. Of the 140 original participants 111 completed this study. Results are presented for those meeting criteria (e.g., full remission, recurrence) at two years and four years.
By two years, 82% had made full remission from their index depressive disorder.By fourth year 93% had made a full remission. However, 20% experienced a recurrence by year 2, and 40% by year 4. 27% made at least one suicide attempt. Only 4% had an onset of bipolar disorder. 80% developed a non mood disorder psychiatric disorder (Anxiety disorders, substance and alcohol disorders, and eating disorder). High anxiety is associated with poor recovery.Poor self efficacy and low socio economic status were associated with recurrence.
Limitations– No comparison group. Axis 2 disorders were not assessed. Memory and recall bias possible.
Comment: Remission from index episode is the norm in adolescent depression. High recurrence is a real challenge for clinicians, patients and carers.
Summary of the article
Melvin GA, Dudley AL, Gordon MS, Ford S, Taffe J, Tonge BJ. J Affect Disord. 2013 Oct;151(1):298-305