Depressed teens on meds lack scrutiny

While most kids on antidepressant drugs get some follow-up care, only 3 percent of the thousands of Minnesota teenagers taking them get as many face-to-face appointments as they should, according to an analysis by the Minnesota Council of Health Plans.

Four years ago, the federal government warned doctors to check frequently on adolescent patients who take antidepressants.

It was all part of a black-box warning issued by the federal Food and Drug Administration (FDA) to reduce the risk of suicidal behavior among the growing number of teenagers who take drugs such as Zoloft and Prozac.

But in Minnesota, the FDA's warning doesn't seem to be working.

"We're just scratching the surface for what ought to be done for adolescent depression," said Dr. David Aughey, director of adolescent medicine for Children's Hospitals and Clinics.

Doctors and other experts say it's likely that doctors, patients and parents are all part of the problem.

Adolescent psychiatrists are scarce and over-subscribed with patients.

The council examined health insurance claims for 2.5 million Minnesotans who were continuously insured in 2005. The analysis found that about one in 10 children suffered from some kind of mental disorder, which is in line with national estimates. Depression, which affected about 5 percent of all kids, was the second most common mental problem after attention deficit disorder. That, too, is in line with national estimates, experts said. Two-thirds of those with depression were getting medications, which doctors said means many are not even getting the drugs that could help them.

But what alarmed health officials most was how few were getting the proper number of follow-up visits.

Earlier studies have shown that depressed kids are at a slightly increased risk for suicidal thinking and suicidal attempts right after they start taking antidepressants. That's why the FDA guidelines say that they should meet with a doctor or other provider at least once a week in the first month they start medications, once every other week in the second month, and once at the end of the third month.

What they found is that about a fourth of the kids ages 5 to 19 got the first visit within a week -- and a fifth didn't get it until three months after they took their first pill. Only 3 percent got all the visits.

Adolescent psychiatrists and pediatricians said that when the new guidelines came out, many primary care physicians were confused about what they were supposed to do during those follow-up visits.

A hard lesson learned

Linda VanEaton, of Stillwater, said it took her several years of struggling with her teenage daughter's depression to figure that out as well. The family physician who first prescribed antidepressants for her daughter about four years ago gave her the standard advice to "come back in two weeks. But that isn't good enough when you are starting an adolescent on psychiatric meds," said VanEaton, 47. She learned that the hard way when her daughter attempted suicide.

She was finally able to find a psychiatrist who works in Stillwater who understands her daughter and the nature of adolescent depression. Her daughter is now in college but still checks in regularly with the psychiatrist, even though it costs the family more.

"It's a life or death thing," she said.

Sulik said that education for both parents and doctors is improving. Parents at CentraCare now get a pamphlet explaining the treatment guidelines. He has held education seminars for primary care doctors.

"Therapy is the more important part of treating adolescent depression," he said. "Medication is a tool that allows the brain to work more effectively, but it's that life skill teaching that is the real core of recovery."