Time to rethink treatments for young people with depression

Young people with depression are likely to experience cognitive difficulties such as poor concentration, memory and problem solving skills that may reduce their ability to respond well to some standard treatments for depression, a new study has found.

The study, led by Dr Kelly Allott and Ms Joanne Goodall at Orygen, the National Centre of Excellence in Youth Mental Health, in collaboration with colleagues at the University of Melbourne, provides the strongest evidence to date of widespread cognitive difficulties in young people aged 12-25 years who have depression.

One in five young people will experience a clinical episode of depression by the time they’re 18. Depression is considered the leading cause of disability worldwide by the United Nations as it can severely impact people’s ability to gain employment, complete education, form and maintain relationships, and, in severe cases, can lead to suicide.

Dr Allott said cognitive issues were a known feature of depression in adults, but were not well understood among youth with depression. This led the research team to collate and analyse the results of 23 previous studies that looked at cognitive functioning in young people with depression. Their research has been published in the journal Neuropsychology Review.

“It is important to look separately at the impact of depression on the cognitive abilities of young people as there is a significant period of brain development that occurs during adolescence and continues until around age 25,” Dr Allott said. “This period of brain development enhances multi-tasking abilities, problem-solving capacity and the ability to process complex information so it’s to be expected that depression will have a different impact on the cognition of young people than it does in adults.”

The study found that young depressed people have difficulty focussing and maintaining attention, particularly if they are on anti-depressants; have difficulty effectively recalling previously presented verbal and visual information; and have trouble with verbal reasoning compared with their non-depressed peers.

“These skills are all fundamental to effectively engaging with recommended treatments for depression, such as cognitive behavioural therapy (CBT),” Dr Allott said. “Treatments such as CBT or talking therapy might therefore not be suitable or need to be adapted for young people with cognitive difficulties who have difficulty engaging with therapies that involve reasoning and other thinking skills”.

This study helps us to better understand depression in young people and provides guidance on how we might better tailor treatment options and intervene early.

“Young people with thinking difficulties such as poor concentration or memory can often feel a sense of worthlessness that feeds into their depression symptoms.”

“Highlighting that this is a part of depression and it’s not who they are, can give them a sense of reassurance and hope about their recovery”, Dr Allott said.