7 June 2018

Strategies for helping depressed teens with cognition issues

Clinical Mental Health Patients

Melbourne psychiatrists are calling for greater recognition of the effect depression has on memory, concentration and problem-solving in teens, saying treatment could be tweaked to improve outcomes.

While the link between cognitive problems and depression is widely accepted among adults, the picture has been less clear among adolescents.

But now a systematic review and meta-analysis of 23 studies by youth mental health research centre Orygen has confirmed the effects were similar, with depressed 12- to 25-year-olds more likely than their peers to have poorer attention, memory, reasoning and IQ.

“We can still improve on existing treatments,” Dr Kelly Allott, a clinical neuropsychiatrist and senior research fellow at Orygen, said.

Considering the effect of cognition was one area their research suggested was important, “because that’s certainly a core feature of illness of depression, and likely impacts on the ability to engage with the existing treatments”.

Dr Allott said that in a follow-up set of yet-unpublished interviews with almost a dozen young people, cognitive difficulties were a major concern affecting them and their ability to engage with therapy.

Yet these patients also reported rarely having this aspect of the condition discussed with them by their doctor and not realising the difficulties they were experiencing were part of the depression.

“In some cases, it was feeding into the negative self-beliefs they had – feeling like they were dumb, [or thoughts like] ‘Why can’t I get this?’ and ‘Why aren’t I learning?’,” she said.

As a result, Dr Allott urged clinicians to make this link clear to patients and normalise the experience. At the same time, she outlined a number of strategies doctors could use with their patients to help improve.

Some examples included having shorter sessions so that the patients weren’t as overwhelmed with details, making sure to write down key information, such as medication type and dosing and any other specifics, and double-checking or asking patients to repeat information to confirm they understood.

For some patients in the earlier stages of treatment, when the depression could be more severe, Dr Allott said she found it useful to switch towards more of a behavioural approach.

This was because cognitive behaviour therapy involved thinking at a higher level, being able to remember the content of the discussion, and then practicing the strategies suggested.

“That’s challenging if you walk out of the room and you can’t remember what was discussed,” Dr Allott said.

So instead, she might tell a patient their homework was to go for a walk once a day, and when things had become more manageable, to then introduce more cognitive work.

Adolescence was also a pivotal time for education and even employment, so advocating for patients by writing a letter to the school explaining that the individual might have difficulty concentrating for this period, or supporting extensions for assignments, could also be helpful.

In the meantime, Dr Allott and her team at Orygen are trialling a new intervention where doctors give their patients with depression a two-sided sheet both outlining how normal it is for cognitive difficulties to arise and providing strategies to combat the most common problems.

These include using diaries and planners, phone-based reminders, taking notes, removing background distractions and having shorter study sessions.

Neuropsychol Rev 2018; online 22 April