What is the appropriate approach to discussing treatment options with a 17-year-old patient with symptoms of depression: should they be discussed first with the patient, then with the parent and patient, or with the parent first, then with the parent and patient, or only with the patient, or only with the parent?

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Last updated: March 17, 2025 • View editorial policy

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From the Guidelines

Treatment options for a 17-year-old patient with symptoms of depression should first be discussed with the patient, then with both the parent and patient together, to respect the patient's autonomy while ensuring family support and involvement. For a 17-year-old with depression, respecting their autonomy while still involving parents appropriately is essential, as emphasized in the guidelines for adolescent depression in primary care (GLAD-PC) 1. Adolescents have the right to confidential mental health care and should be included in treatment decisions from the beginning. This approach builds trust with the adolescent patient and increases treatment adherence.

Key Considerations

  • The patient's preferences and the availability of treatment services should be taken into account when developing a treatment plan 1.
  • A "common factors" approach, focused on evidence-based practices such as better communication skills, being supportive, and engaging in shared decision-making, is recommended 1.
  • Treatment options might include cognitive behavioral therapy, interpersonal therapy, and possibly selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, which is FDA-approved for adolescent depression.
  • The involvement of both patient and parents improves outcomes by creating a supportive environment for treatment implementation.

Customizing the Treatment Plan

The treatment plan should be customized according to the severity of disease, risk of suicide, and the existence of comorbid conditions, as outlined in the GLAD-PC guidelines 1. Common sense approaches such as the prescription of physical exercise, sleep hygiene, and adequate nutrition should also be used in the management of these patients. By discussing treatment options with the patient first and then involving parents, clinicians can ensure that the patient's needs and preferences are respected while also ensuring that parents are involved and supportive of the treatment plan.

From the Research

Approaches to Discussing Treatment Options

  • There is no direct evidence in the provided studies to suggest a specific approach to discussing treatment options with a 17-year-old patient with symptoms of depression, such as whether to discuss options first with the patient, then with the parent and patient, or with the parent first, then with the parent and patient, or only with the patient, or only with the parent.
  • However, the studies suggest that treatment of adolescent depression often involves a combination of psychotherapy and medication, and that parental involvement may be important in the treatment process 2, 3, 4, 5, 6.
  • For example, the TADS study found that the combination of fluoxetine with cognitive-behavioral therapy (CBT) was the most effective treatment for adolescents with major depressive disorder, and that this treatment was associated with a significant reduction in suicidal thinking 6.
  • The IMPACT Study, which used a psychodynamic approach to treating adolescent depression, involved 28 sessions of psychotherapy with the patient, as well as 7 sessions of parent/carer work 3.
  • The American Family Physician study recommends that treatment for adolescent depression be initiated after a confirmed diagnosis, and that active support and monitoring may be sufficient for mild, self-limited depression, while more severe depression may require a combination of psychotherapy and medication 4.

Involvement of Parents in Treatment Discussions

  • The studies suggest that parents may play an important role in the treatment process for adolescent depression, particularly in terms of providing support and monitoring the patient's progress 3, 4, 5.
  • However, the studies do not provide clear guidance on whether parents should be involved in initial discussions about treatment options, or whether the patient should be involved in these discussions as well 2, 6.
  • The TADS study found that the combination of fluoxetine with CBT was the most effective treatment for adolescents with major depressive disorder, but it does not provide information on how treatment options were discussed with patients and their parents 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Psychodynamic psychotherapy as treatment for depression in adolescence.

Child and adolescent psychiatric clinics of North America, 2013

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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