Disorders - depressive disorders
Eskin, M., Ertekin, K., Demir, H.
Short-term and structured
cognitive behavioral problem-solving therapy (PST) is a developmentally relevant mode of action for the treatment of emotional problems in young
people. This study aimed at testing the efficacy of a problem-solving therapy in treating depression and suicide potential in adolescents and young
adults. A total of 46 self-referred high school and university students who were randomly assigned to a problem-solving therapy (n = 27) and a
waiting list control (n = 19) conditions completed a controlled cognitive behavioral problem-solving treatment trial. Participants were administered
the measures of depression, suicide potential, problem solving, self-esteem and assertiveness. Twenty-two of the 27 participants from the PST
condition could be reached after 12-months for follow-up. Participants completed depression and problem-solving measures at follow-up. Results showed
that post-treatment depression and suicide risk scores of participants within the PST condition decreased significantly compared to the pre-treatment
scores but post-waiting and pre-waiting depression and suicide risk scores of participants within the WLC condition were unchanged. Likewise, post-
treatment self-esteem and assertiveness scores of participants within the PST condition increased significantly compared to the pre-treatment scores
while post-waiting and pre-waiting self-esteem and assertiveness scores of participants within the WLC condition were unchanged. At post-treatment,
77.8% of the participants in the PST but only 15.8% of those in the WLC condition achieved full or partial recovery according to BDI scores.
Similarly, 96.3% of participants in the PST but only 21.1% of those in the WLC condition achieved full or partial recovery according to HDRS scores.
The improvements were maintained at 12-months follow-up. Therefore, it is concluded that problem-solving therapy should be considered as a viable
option for the treatment of depression and suicide potential in adolescents and young adults. copyright 2007 Springer Science+Business Media,
LLC.
Cognitive Therapy & Research., 32(2) : 227-245
- Year: 2008
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Problem solving therapy (PST)
Foley, L.
S., Prapavessis, H., Osuch, E. A., De Pace, J. A., Murphy, B. A., Podolinsky, N. J.
The purpose of the pilot study was to explore the psychological, cognitive and
physiological changes accompanying exercise-mediated amelioration of clinical depression. Depressed participants were randomly assigned to either a
12-week aerobic exercise (n = 10) or stretching (n = 13) program. The outcome variables were depression severity, coping efficacy, episodic memory
and cortisol awakening response (CAR). Both aerobic exercise and stretching were associated with significant decreases in severity of depression, and
increases in coping efficacy and episodic memory over 12 weeks. CAR decreased in the aerobic exercise group and increased in the stretching group
over 12 weeks. Change in depression severity was significantly inversely associated with change in coping efficacy and change in episodic memory. No
significant correlations were found between CAR and the other outcome variables. Overall, this study demonstrates that exercise and stretching are
associated with positive psychological and cognitive changes in those with depression. (copyright) 2008 Elsevier Ltd. All rights reserved.
Mental Health & Physical Activity, 1(2) : 69-
73
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Emslie, G.
J., Kennard, B. D., Mayes, T. L., Nightingale-Teresi, J., Carmody, T., Hughes, C. W., Rush, A. J., Tao, R., Rintelmann, J. W.
Objective: The authors compared fluoxetine and placebo in continuation treatment to prevent relapse of major depressive disorder in
children and adolescents. Method: After a detailed evaluation, children and adolescents 7-18 years of age with major depressive disorder were treated
openly with fluoxetine. Those who had an adequate response after 12 weeks, as indicated by a Clinical Global Impression improvement score of 1 or 2
and a decrease of at least 50% in Children's Depression Rating Scale - Revised score, were randomly assigned to receive fluoxetine or placebo for an
additional 6 months. The primary outcome measures were relapse and time to relapse. Relapse was defined as either a score of 40 or higher on the
Children's Depression Rating Scale with a history of 2 weeks of clinical deterioration, or clinical deterioration as judged by the clinician.
Additional analyses were conducted with relapse defined only as a score of 40 or higher on the Children's Depression Rating Scale. Results: Of 168
participants enrolled in acute fluoxetine treatment, 102 were randomly assigned to continuation treatment with fluoxetine (N=50) or placebo (N=52).
Of these, 21 participants (42.0%) in the fluoxetine group relapsed, compared with 36 (69.2%) in the placebo group, a significant difference.
Similarly, under the stricter definition of relapse, fewer participants in the fluoxetine group relapsed (N=11; 22.0%) than in the placebo group
(N=25; 48.1%). Time to relapse was significantly shorter in the placebo group. Conclusions: Continuation treatment with fluoxetine was superior to
placebo in preventing relapse and in increasing time to relapse in children and adolescents with major depression.
American Journal of
Psychiatry, 165(4) : 459-467
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Layne, C.M., Saltzman, W.R., Poppleton, L., Burlingame, G.M., Pasa- lic, A., Durakovic, E., et al.
To evaluate the
comparative effectiveness of a classroom-based psychoeducation and skills intervention (tier 1) and a school-based trauma- and grief-focused group
treatment (tier 2) of a three-tiered mental health program for adolescents exposed to severe war-related trauma, traumatic bereavement, and postwar
adversity.\rMethod\r\rA total of 127 war-exposed and predominantly ethnic Muslim secondary school students attending 10 schools in central Bosnia who
reported severe symptoms of posttraumatic stress disorder (PTSD), depression, or maladaptive grief and significant impairment in school or
relationships were randomly assigned to one of two experimental conditions. These included either an active-treatment comparison condition (tier 1),
consisting of a classroom-based psychoeducation and skills intervention alone (n = 61, 66% girls, mean age 16.0 years, SD 1.13) or a treatment
condition composed of both the classroom-based intervention and a 17-session manual-based group therapy intervention (tier 2), trauma and grief
component therapy for adolescents (n = 66, 63% girls, mean age 15.9 years, SD 1.11). Both interventions were implemented throughout the school year.
Distressed students who were excluded from the study due to acute risk for harm (n = 9) were referred for community-based mental health services
(tier 3).\rResults\r\rProgram effectiveness was measured via reductions in symptoms of PTSD, depression, and maladaptive grief assessed at
pretreatment, posttreatment, and 4-month follow-up. Analysis of mean-level treatment effects showed significant pre- to posttreatment and
posttreatment to 4-month follow-up reductions in PTSD and depression symptoms in both the treatment and comparison conditions. Significant pre- to
posttreatment reductions in maladaptive grief reactions were found only in the treatment condition. Analyzed at the individual case level, the
percentages of students in the treatment condition who reported significant (p < .05) pre- to posttreatment reductions in PTSD symptoms (58% at
posttreatment, 81% at 4-month follow-up) compare favorably to those reported in controlled treatment efficacy trials, whereas the percentages who
reported significant reductions in depression symptoms (23% at posttreatment, 61% at follow-up) are comparable to, or higher than, those found in
community treatment settings. Lower but substantial percentages of significant symptom reduction were found for PTSD (33% at posttreatment, 48% at
follow-up) and depression symptoms (13% at posttreatment; 47% at follow-up) in students in the comparison condition. The odds of significant symptom
reduction were higher for PTSD symptoms at both posttreatment and 4-month follow-up and for maladaptive grief at posttreatment (no follow-up was
conducted on maladaptive grief). Rates of significantly worsened cases were generally rare in both the treatment and comparison conditions.
\rConclusions\r\rA three-tiered, integrative mental health program composed of schoolwide dissemination of psychoeducation and coping skills (tier
1), specialized trauma- and grief-focused intervention for severely traumatized and traumatically bereaved youths (tier 2), and referral of youths at
acute risk for community-based mental health services (tier 3) constitutes an effective and efficient method for promoting adolescent recovery in
postwar settings. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(9): 1048 - 1062.
Journal of the American Academy of
Child & Adolescent Psychiatry, 47(9) : 1048-1062.
- Year: 2008
- Problem: Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Skills training, Other Psychological Interventions
Kennard, B.
D., Emslie, G. J., Mayes, T. L., Nightingale-Teresi, J., Nakonezny, P. A., Hughes, J. L., Jones, J. M., Tao, R., Stewart, S. M., Jarrett, R. B.
Objective: We present results of a
feasibility test of a sequential treatment strategy using continuation phase cognitive-behavioral therapy (CBT) to prevent relapse in youths with
major depressive disorder (MDD) who have responded to acute phase pharmacotherapy. Method: Forty-six youths (ages 11-18 years) who had responded to
12 weeks of treatment with fluoxetine were randomized to receive either 6 months of continued antidepressant medication management (MM) or
antidepressant MM plus relapse prevention CBT (MM+CBT). Primary outcome was time to relapse, defined as a Childhood Depression Rating Scale-Revised
score of 40 or higher and 2 weeks of symptom worsening or clinical deterioration warranting alteration of treatment to prevent full relapse. Results:
Cox proportional hazards regression, adjusting for depression severity at randomization and for the hazard of relapsing by age across the trial,
revealed that participants in the MM treatment group had a significantly greater risk for relapse than those in the MM+CBT treatment group (hazard
ratio = 8.80; 95% confidence interval 1.01-76.89; (chi)2 = 3.86, p = .049) during 6 months of continuation treatment. In addition, patient
satisfaction was significantly higher in the MM+CBT group. No differences were found between the two treatment groups on attrition rate, serious
adverse events, and overall global functioning. Conclusions: These preliminary results suggest that continuation phase CBT reduces the risk for
relapse by eightfold compared with pharmacotherapy responders who received antidepressant medication alone during the 6-month continuation phase.
(copyright)2008 by the American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 47(12) : 1395-
1404
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Possel, P., Seemann, S., Hautzinger, M.
Despite the well-known relevance of comorbidity, few studies have examined the impact of comorbid anxiety or externalizing
symptoms on the prevention of depressive symptoms in adolescents. To replicate earlier positive effects of a cognitive-behavioral prevention program
of depressive symptoms and to test the hypothesis that the prevention program would be less effective in adolescents with comorbid anxiety and
externalizing symptoms, the authors conducted a study involving 301 8th-grade students randomly divided into an intervention group and a
nonintervention control group. The randomized design included baseline, postintervention, and 6-month follow-up. The prevention program included 10
sessions held in a regular school setting. The prevention program showed positive effects on depressive symptoms independent of comorbid symptoms.
These effects were found mainly with girls independent of their depressive symptoms at baseline, and in part with boys with less severe depressive
symptoms at baseline. It is surprising that negative effects of the prevention program on depressive symptoms were found on the depression of boys
with more severe depressive symptoms at baseline. The prevention program's low rate of attrition and high recruitment rate support the
generalizability of the results.
Journal of Counseling
Psychology, 55(1) : 106-17
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Stice,
E., Rohde, P., Seeley, J. R., Gau, J. M.
In this depression prevention
trial, 341 high-risk adolescents (mean age = 15.6 years, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-
behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed
significantly greater reductions in depressive symptoms than did supportive-expressive, bibliotherapy, and assessment-only participants at posttest,
though only the difference compared with assessment controls was significant at 6-month follow-up. CB participants showed significantly greater
improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than did participants in all 3 other conditions.
Supportive-expressive and bibliotherapy participants showed greater reductions in depressive symptoms than did assessment-only controls at certain
follow-up assessments but produced no effects for social adjustment and substance use. CB, supportive-expressive, and bibliotherapy participants
showed a significantly lower risk for major depression onset over the 6-month follow-up than did assessment-only controls. The evidence that this
brief CB intervention reduced risk for future depression onset and outperformed alternative interventions for certain ecologically important outcomes
suggests that this intervention may have clinical utility. (copyright) 2008 American Psychological Association.
Journal of Consulting & Clinical Psychology, 76(4) : 595
-606
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Supportive
therapy, Self-help
Tsapakis, E. M., Soldani, F., Tondo, L., Baldessarini, R. J.
Background: The safety of antidepressants in children and adolescents is being questioned and the efficacy of these drugs in
juvenile depression remains uncertain. Aims: To assess antidepressant efficacy in juvenile depression. Method: Systematic review and meta-analysis of
randomised controlled trials (RCTs) comparing responses to antidepressants, overall and by type, v. placebo in young people with depression. Results:
Thirty drug-placebo contrasts in RCTs lasting 8 weeks (median) involved 3069 participants (512 person-years) of average age 13.5 years. Meta-analysis
yielded a modest pooled drug/placebo response rate ratio (RR=1.22, 95% CI 1.15-1.31), with little separation between antidepressant types. Findings
were similar for response rate differences and corresponding number needed to treat (NNT): overall NNT=9; tricyclic antidepressants NNT=14 >
serotonin reuptake inhibitors NNT=9 > other antidepressants NNT=8. Numbers needed to treat decreased with increasing age: children (NNT=21) > mixed
ages (NNT=10) > adolescents (NNT=8). Conclusions: Antidepressants of all types showed limited efficacy in juvenile depression, but fluoxetine might
be more effective, especially in adolescents. Studies in children and in severely depressed, hospitalised or suicidal juvenile patients are needed,
and effective, safe and readily accessible treatments for juvenile depression are urgently required.
British Journal of Psychiatry, 193(1) : 10-
17
- Year: 2008
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any)
Usala, T., Clavenna, A., Zuddas, A., Bonati, M.
To evaluate the efficacy of selective
serotonin reuptake inhibitors (SSRIs) in children and adolescents with depressive disorder, the main electronic databases and the reference lists of
retrieved articles and reviews were searched up to January 2007. Randomized controlled studies (RCT) were assessed for methodological quality, taking
into consideration the specific diagnostic and severity evaluation tools used, and a meta-analysis on the efficacy of SSRIs compared placebo was
undertaken. In all, 13 studies were included, covering a total of 2530 children and adolescents. Eleven studies met the criteria for inclusion in the
meta-analysis. The pooled odds ratio was 1.57 (95% C.I. 1.29-1.91). Only fluoxetine appeared to offer a moderately significant benefit profile (OR =
2.39). All studies differed in diagnostic tools and primary efficacy measures. SSRI treatment, especially with fluoxetine, may be effective on child
and adolescent depression. Nevertheless, additional RCTs with sound methodological designs, validated diagnostic instruments, large sample sizes, and
consistent outcomes are necessary to determine the role of SSRIs, alone or in combination with psychological interventions in the treatment of
depression in children and adolescents. (copyright) 2007 Elsevier B.V. and ECNP.
European Neuropsychopharmacology, 18(1) : 62-73
- Year: 2008
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
VanVoorhees, B. W., Vanderplough-Booth, K., Fogel, J., Gladstone, T., Bell, C., Stuart,
S., Gollan, J., et-al
Background: Adolescent depression is both a major public
health and clinical problem, yet primary care physicians have limited intervention options. We developed two versions of an Internet-based behavioral
intervention to prevent the onset of major depression and compared them in a randomized clinical trial in 13 US primary care practices. Methods: We
enrolled 84 adolescents at risk for developing major depression and randomly assigned them to two groups: brief advice (BA; 1-2 minutes) + Internet
program versus motivational interview (MI; 5-15 minutes) + Internet program. We compared pre/post changes and between group differences for
protective and vulnerability factors (individual, family, school and peer). Results: Compared with pre-study values, both groups demonstrated
declines in depressed mood; [MI: 21.2 to 16.74 (p < 0.01), BA: 23.34 to 16.92 (p < 0.001)]. Similarly, both groups demonstrated increases in social
support by peers [MI: 8.6 to 12.1 (p = 0.002), BA: 7.10 to 12.5 (p < 0.001)] and reductions in depression related impairment in school [MI: 2.26 to
1.76 (p = 0.06), BA: 2.16 to 1.93 (p = 0.07)]. Conclusions: Two forms of a primary care/Internet-based behavioral intervention to prevent adolescent
depression may lower depressed mood and strengthen some protective factors for depression.
Journal of the Canadian Academy of Child & Adolescent Psychiatry, 17(4) : 184-
196
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Vuori, J., Koivisto, P., Mutanen,
P., Jokisaari, M., Salmela-Aro, K.
The Towards
Working Life group method was designed to promote the transition to the upper secondary level or vocational studies and to support mental health
among young people finishing their basic education. This study examined the effects of the intervention during upper secondary and vocational studies
in a randomized field experimental study among a total of 1034 students. At the one-year follow-up, the program had increased both education related
social ties and the number of adults in these ties. The group intervention had interaction effects with baseline risk of depression and learning
difficulties on symptoms of depression and school burnout. Among those initially at risk of depression, the intervention decreased symptoms of
depression. For students who were at risk of depression and had learning difficulties, the intervention decreased school burnout.
, 72(1) : 67-80
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational
interventions
Wilkinson, P. O., Goodyer, I. M.
Background: A mood-
related ruminative response style increases the risk of onset and persistence of depression. This preliminary study investigated whether, in
depressed adolescents, cognitive-behaviour therapy reduces mood-related ruminative response style. Whether specific factors within the rumination
scale were differentially affected by CBT is also reported. Methods: 26 depressed adolescents were randomised to receiving serotonin-specific
reuptake inhibitor antidepressants (SSRI) plus psychosocial treatment as usual or SSRI and psychosocial treatment as usual plus CBT. Ruminative
response style and depressive symptoms were measured at baseline and after 30 weeks of treatment, with the Responses to Depression Questionnaire and
Mood and Feelings Questionnaire. Results: There were significantly greater reductions in ruminations in the CBT group compared to the non-CBT group
(p = .002). There was no significant difference in the reduction in self-reported depressive symptoms between the groups. Rumination was reduced to
levels of never-depressed controls in adolescents who had recovered from depression and received CBT. There were greater falls in the CBT group in
the more pathological 'brooding' factor of rumination. Conclusion: These findings suggest that adding CBT to SSRI medication in the presence of
active clinical care causes a greater reduction in mood-related ruminative response style in depressed adolescents. This may reduce the risk of
future relapse. (copyright) 2008 Wilkinson and Goodyer; licensee BioMed Central Ltd.
Child & Adolescent Psychiatry & Mental
Health, 2 :
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)