Does Teen Depression Reduce the Effectiveness of Substance Treatment?

Posted on January 27th, 2015
Posted in Teens

A review of 13 studies on the impact of depression on teens entering substance abuse treatment has found mixed results. While depression hindered the ability of some teens to stay active in treatment, other teens had better results than their counterparts not affected by depression.

Significant numbers of American teenagers have symptoms that qualify them for a diagnosis of major depression or some other form of depressive disorder. In addition, significant numbers of American teens affected by depression also have diagnosable problems with substance abuse and/or substance addiction (the two aspects of substance use disorder). In a study review published in 2014 in the journal Substance Abuse, researchers from two U.S. universities sought to determine if co-occurring problems with depression and substance use disorder interfere with the effectiveness of substance treatment for teenagers.

Teenagers and Depression

Roughly one out of every 10 American teens has diagnosable symptoms of major depression, persistent depressive disorder or some other depressive illness, the National Institute of Mental Health reports. Generally speaking, teenage girls have higher chances of developing a depressive illness than teenage boys. For both girls and boys, the odds of experiencing depression rise over time. Just like adults below the age of 45, teenagers over the age of 14 develop major depression more often than any other form of mental illness.

Adolescents have depression symptoms that can differ substantially from the symptoms found in adults. For this and other reasons, doctors once believed that teenagers and younger children were incapable of developing a depressive illness. Potential unique manifestations of depression in a teenage boy or girl may include conduct problems in school, a sullen or highly irritable mood, a generally negative outlook and a sense of social isolation from peers and/or adults. All of these symptoms can mimic fairly common, non-depression-related changes in attitude that occur in large segments of the adolescent population. For this reason, doctors sometimes have a hard time identifying the presence of depression in their teen patients.

Depression and Substance Use Disorder

Along with various forms of bipolar disorder, depressive illnesses form part of a larger category of mental illnesses known as mood disorders. Mood disorders appear relatively frequently in people who have diagnosable problems with drugs (including nicotine/tobacco) and/or alcohol, the National Institute on Drug Abuse notes. In addition, mood disorders and substance use disorder are comorbid conditions. This means that, when they appear in a person dealing with substance abuse and/or substance addiction, depressive illnesses and bipolar illnesses take a different course and often have worse overall effects than when they occur on their own. It also means that, when they appear in a person dealing with depression or bipolar disorder, substance abuse and substance addiction take a different course and often have worse overall effects than when they occur on their own.

Depression’s Impact on Teen Substance Treatment

In the study review published in Substance Abuse, researchers from Duke University and the University of Connecticut analyzed the results of 13 previous studies that explored the impact of comorbid depression and substance problems on the effectiveness of teen substance treatment. Specifically, the researchers wanted to know if some of the classic symptoms of depression (e.g., lethargy and a lack of motivation) decrease adolescents’ ability to participate fully in their substance treatment programs. Conversely, they also wanted to know if the mental distress associated with depression can increase adolescents’ willingness to receive help and stay active in substance treatment. All of the studies included in the review focused on young people between the ages of 12 and 21. In addition, all of the studies assessed their participants for depression symptoms and examined either the end results of substance treatment or the ability of teenagers to remain enrolled in substance treatment.

After completing their review, the researchers concluded that evidence on the substance treatment-related impact of comorbid depression and substance problems in teenagers is mixed. In some cases, the combined presence of these issues did not make any notable difference in teens’ substance treatment enrollment or outcomes. In other cases, the combined presence of depression and substance problems clearly hindered teenagers’ ability to stay active in substance treatment or benefit sufficiently from treatment. In a third set of cases, teens affected by a combination of depression and substance problems actually had better records of substance treatment than their program counterparts unaffected by depression.

The study review’s authors note that the studies they analyzed included a wide range of substance treatment programs that, among other variations, took place in different settings, included adolescents with different types of depressive illness and measured successful treatment outcomes in different ways. They believe that further research is required to determine if any of these variables have a decisive impact on the effectiveness of substance treatment in teens dealing with comorbid depression symptoms.

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