15% to 20%, 1 current prevalence is estimated as high as 6%, 2 and 28.3% of adolescents report periods during the past year of depressive symptoms leading to impairment. 3 Untreated depression is associated with suicide, a leading cause of death for youth aged 15 to 24 years, 4,5 and with other negative outcomes including school dropout, pregnancy, substance abuse, and adult depression. 2,[5][6][7][8][9] The treatment literature supports efficacy for cognitive-behavior therapy (CBT), 10-14 interpersonal psychotherapy, [14][15][16] and some selective serotonin reuptake inhibitors, [17][18][19][20][21] with recent data indicating an advantage of combined CBT and medication for the treatment of adolescent major depression. 21 Practice parameters have been developed and algorithms tested to guide pharmacotherapy. [22][23][24] However, due to uncertainty regarding the safety and efficacy of selective seroto-Author Affiliations and Financial Disclosures are listed at the end of this article.

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In this randomized effectiveness trial of a primary care quality improvement intervention for depressed youths, the main effect of the intervention on outcomes was to decrease the likelihood of severe depression at the 6-month outcome assessment. These early intervention-related improvements conferred additional long-term protection through a favorable shift in illness course through 12 and 18 months.

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