Talk therapy can be a cost- effective way to help teens with depression who choose not to take antidepressant medications, according to a new study from the Kaiser Permanente Center for Health Research in Portland, Ore.
Antidepressants are typically used to treat depression, but nearly half of all families with a depressed child decide against using these medications, according to the researchers. Moreover, almost half of teens who do start taking antidepressants eventually stop using them because of side effects, cost or lack of noticeable improvement in their condition.
“Untreated or undertreated depression is a serious burden for many adolescents and their families, and the impact is often felt for many years after diagnosis,” said the study’s lead author, Kaiser Permanente health economist John Dickerson.
Depression is one of the most common mental disorders among adolescents, with many negative consequences. They include impaired function and increased risk for problems such as substandard academic performance, substance abuse, relationship problems and suicide.
Dickerson and his colleagues examined the cost-effectiveness of talk therapy — called cognitive behavioral therapy (CBT) — among 212 depressed teens in Oregon and Washington state.
CBT is a short-term, goal-oriented psychotherapy treatment that takes a practical approach to problem-solving. It is designed to change patterns of thinking or behavior that may be underlying people’s difficulties, thereby changing the way they feel.
In the Kaiser Permanente study covering a two-year period, depression-related health care costs for those who received CBT averaged about $5,000 less than for those who received usual care without the talk therapy, the findings showed.
In addition to the actual cost of delivering the therapy, the researchers included other elements of care, such as the cost of medical and mental health services, hospitalization, and costs related to the time parents spent taking their children to treatments.
“Now we have evidence that CBT is not only clinically effective, but cost-effective as well. This is good news for patients, their families and health care systems,” Dickerson said in a Kaiser Permanente news release.
He pointed out that most other studies of CBT for depressed youths that the researchers reviewed involved much longer treatment regimens than the one they tested. They chose a “leaner” treatment model with fewer CBT sessions because that type of model is more likely to be adopted by health care providers, he added.
“It’s important for health systems and families to know that a brief CBT program is likely to improve mental health outcomes for depressed adolescents who decline antidepressants — and is also likely to be cost-effective over time,” Dickerson said.
A total of 212 youth with depression were randomly assigned to treatment as usual (TAU) or TAU plus brief individual CBT. Clinical outcomes included depression-free days (DFDs) and estimated quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICERs) comparing CBT to TAU were calculated over 12- and 24-month follow-up periods.
By the end of the 24 month followup among youth randomly assigned to CBT, total treatment costs were $4,976 less, researchers found.
To help evaluate new treatments and inform public health policies, researchers at the center developed new clinical measurement tools for assessing the full impact of depression on teenagers’ lives. The findings were published in the February issue of the journal Pediatrics