Datapoints: Receipt of Psychotherapy by Adolescents Taking Antidepressants

Two recent major randomized clinical trials of adolescent depression treatment, the Treatment for Adolescents with Depression Study ( 1 ) and the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Randomized Controlled Trial ( 2 ), have found enhanced efficacy and safety from combining cognitive-behavioral therapy with antidepressant therapy.

This column presents data on the percentage of children with Medicaid or private insurance taking antidepressants with and without psychotherapy. Low rates of psychotherapy receipt may signal opportunities for improving the quality of depression treatment for adolescents.

The data are from the 2004–2006 MarketScan Commercial Claims and Encounters and Medicaid Databases. The commercial database captures claims from four million to 22 million individuals annually. The Medicaid database includes over eight million individuals per year from seven geographically dispersed states.

The study included children ages 13 to 17 who filled a new prescription for an antidepressant medication and who were continuously enrolled over the study period. A new prescription was defined as a prescription fill with no antidepressant prescription fills in the prior three months. The percentage of children receiving any psychotherapy in the six months after the index prescription was calculated by using CPT codes for psychotherapy (90804–90824, 90826–90829, 90843–90849, 90853, 90855, 90857, M0064, H004, and H1011).

As shown in Table 1, the data reveal that 28.2% of adolescents with Medicaid coverage and 33.6% of adolescents with private insurance who filled a new antidepressant prescription received psychotherapy within six months of the fill. Even among adolescents who filled three or more antidepressant prescriptions, less than one-third with Medicaid and less than one-half with private insurance received psychotherapy.

The study limitations include the fact that psychotherapy paid for completely out of pocket and not submitted for insurance reimbursement was not captured. Additionally, the data do not indicate use of particular types of antidepressants or psychotherapy.

Clearly, there is a need for more guidance regarding when psychotherapy should be provided with antidepressant treatment and the potential benefits from increasing the relatively low rates of receipt in real-world settings.