Disorders - depressive disorders
Rohde, P., Silva, S.
G., Tonev, S. T., Kennard, B. D., Vitiello, B., Kratochvil, C. J., Reinecke, M. A., Curry, J. F., Simons, A. D., March, J. S.
Context: The Treatment for Adolescents With Depression Study evaluated fluoxetine (FLX),
cognitive behavioral therapy (CBT), and FLX/CBT combination (COMB) vs pill placebo in 439 adolescents with major depressive disorder. Treatment
consisted of 3 stages: (1) acute (12 weeks), (2) continuation (6 weeks), and (3) maintenance (18 weeks). Objective: To examine rates of achieving and
maintaining sustained response during continuation and maintenance treatments. Design: Randomized controlled trial. Response was determined by
blinded independent evaluators. Setting: Thirteen US sites. Patients: Two hundred forty-two FLX, CBT, and COMB patients in their assigned treatment
at the end of stage 1. Interventions: Stage 2 treatment varied based on stage 1 response. Stage 3 consisted of 3 CBT and/or pharmacotherapy sessions
and, if applicable, continued medication. Main Outcome Measures: Sustained response was defined as 2 consecutive Clinical Global Impression-
Improvement ratings of 1 or 2 (\"full response\"). Patients achieving sustained response were classified on subsequent nonresponse status. Results:
Among 95 patients (39.3%) who had not achieved sustained response by week 12 (29.1% COMB, 32.5% FLX, and 57.9% CBT), sustained response rates during
stages 2 and 3 were 80.0% COMB, 61.5% FLX, and 77.3% CBT (difference not significant). Among the remaining 147 patients (60.7%) who achieved
sustained response by week 12, CBT patients were more likely than FLX patients to maintain sustained response through week 36 (96.9% vs 74.1%;
P=.007; 88.5% of COMB patients maintained sustained response through week 36). Total rates of sustained response by week 36 were 88.4% COMB, 82.5%
FLX, and 75.0% CBT. Conclusions: Most adolescents with depression who had not achieved sustained response during acute treatment did achieve that
level of improvement during continuation and maintenance therapies. The possibility that CBT may help the subset of adolescents with depression who
achieve early sustained response maintain their response warrants further investigation. Trial Registration: clinicaltrials.gov Identifier:
NCT00006286. (copyright)2008 American Medical Association. All rights reserved.
Archives of General Psychiatry, 65(4) : 447-455
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Rossello, J., Bernal, G., Rivera-Medina, C.
This study compared individual (I) to group (G) formats of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy
(IPT) for the treatment of depression in adolescents. One hundred and 12 Puerto Rican adolescents were randomized to four conditions (CBT-I, CBT-G,
IPT-I, IPT-G). Participants were assessed at pretreatment and posttreatment with structured interviews to establish diagnosis and with self-report
measures to assess treatment outcome. The results suggest that CBT and IPT are robust treatments in both group and individual formats. However, CBT
produced significantly greater decreases in depressive symptoms and improved self-concept than IPT. The implications of these findings are discussed.
(copyright) 2008 American Psychological Association.
Cultural Diversity & Ethnic Minority Psychology, 14(3) : 234-
245
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Interpersonal therapy (IPT)
Riggs,
Pd, Mikulich-Gilbertson, S. K., Davies, R. D., Lohman, M., Klein, C., Stover S. K.
Objective: To evaluate the effect of fluoxetine hydrochloride vs placebo on major
depressive disorder, substance use disorder (SUD), and conduct disorder (CD) in adolescents receiving cognitive behavioral therapy (CBT) for SUD.
Design: Randomized controlled trial. Setting: A single-site study conducted between May 2001 and August 2004. Participants: One hundred twenty-six
adolescents aged 13 to 19 years recruited from the community and meeting Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)
diagnostic criteria for current major depressive disorder, lifetime CD, and at least 1 nontobacco SUD. Interventions: Sixteen weeks of fluoxetine
hydrochloride, 20 mg/d, or placebo, with CBT. Main Outcome Measures: For depression, Childhood Depression Rating Scale-Revised and Clinical Global
Impression Improvement; for SUD, self-reported nontobacco substance use and urine substance use screen results in the past 30 days; and for CD,
self-reported symptoms in the past 30 days. Results: Fluoxetine combined with CBT had greater efficacy than did placebo and CBT according to changes
on the Childhood Depression Rating Scale-Revised (effect size, 0.78) but not on the Clinical Global Impression Improvement treatment response (76%
and 67%, respectively; relative risk, 1.08). There was an overall decrease in self-reported substance use (4.31 days; 95% confidence interval, 2.12-
6.50) and CD symptoms (relative risk, 1.20; 95% confidence interval, 0.82-1.59), but neither difference between groups was statistically significant.
The proportion of substance-free weekly urine screen results was higher in the placebo-CBT group than in the fluoxetine-CBT group (mean difference,
2.10; 95% confidence interval, 0.37-4.15). Conclusions: Fluoxetine and CBT had greater efficacy than did placebo and CBT on one but not both
depression measures and was not associated with greater decline in self-reported substance use or CD symptoms. The CBT may have contributed to
higher-than-expected treatment response and mixed efficacy findings, despite its focus on SUD.
Archives of Pediatrics & Adolescent Medicine, 161(11) : 1026-
34
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Spielmans, G. I., Pasek, L. F., McFall,
J. P.
Prior meta-analytic reviews have
indicated that cognitive and behavioral treatments are efficacious in treating child and adolescent depression and anxiety. Further, a meta-analysis
has suggested that behavioral treatments are superior to nonbehavioral treatments for treating anxiety and depression in youth. However, the prior
meta-analysis did not examine direct comparisons between cognitive and behavioral treatments (CBT) and non-CBT treatments, leaving open the
possibility that their results were artifactual. The present meta-analysis aggregated results of studies in which CBT treatments were compared with
either other bona fide treatments (including other CBT therapies) or non-bona fide therapies. The heterogeneity of the distribution of differences
between bona fide treatments as well as a comparison of full (e.g. CBT + Parent training) versus component treatments (e.g., CBT only) were examined.
The results indicated that: (a) CBT was more efficacious than non-bona fide therapies; (b) CBT was no more efficacious than bona fide non-CBT
treatments (c) the differences between bona fide treatments were homogenously distributed around zero; and (d) full CBT treatments offered no
significant benefit over their components. The results strongly suggest that the theoretically purported critical ingredients of CBT are not
specifically ameliorative for child and adolescent depression and anxiety. copyright 2007 Elsevier Ltd. All rights reserved.
Clinical Psychology Review., 27(5) : 642-
654
- Year: 2007
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Vuijk, Patricia, vanLier, Pol A. C., Crijnen, Alfons A. M., Huizink, Anja C.
The aim of this study was to test for sex differences in the role of
physical and relational victimization in anxiety and depression development through a randomized prevention trial. 448 seven-year-old boys and girls
were randomly assigned to the Good Behavior Game intervention, a two-year universal classroom based intervention aimed at reducing disruptive
behavior problems and creating a safe and predictable classroom environment, or to a control condition. Assessments of self-reported physical and
relational victimization at age 10 years, and self-reported major depressive disorder, generalized anxiety, social anxiety, and panic/agoraphobia
symptoms at age 13 years were available. Reductions in anxiety/depression were mediated by reduced rates of relational victimization in girls,
whereas reductions in physical victimization accounted for the reduced anxiety/depression scores among boys. The results support sex-specific
pathways of victimization leading to anxiety and depression.
Journal of Affective
Disorders, 100(1-3) : 221-6
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Watanabe, N., Hunot, V., Omori, I.
M., Churchill, R., Furukawa, T. A.
Objective: To examine the clinical benefit, the harm and
the cost-effectiveness of psychotherapies in comparison with no treatment, waiting-list controls, attention-placebos, and treatment as usual in
depressed youths. Method: Meta-analyses were undertaken by using data from all relevant randomized-controlled trials identified by a comprehensive
literature search. The primary outcome was relative risk (RR) of response. Results: We identified 27 studies containing 35 comparisons and 1744
participants. At post-treatment, psychotherapy was significantly superior (RR = 1.39, 95% CI 1.18-1.65, P = 0.0001, number-needed to treat 4.3).
There was an evidence of the existence of small study effects, including a publication bias (P < 0.001). The superiority of psychotherapy was no
longer statistically significant (1.18 [0.94-1.47], P = 0.15) at 6-month follow-up. None of the studies reported adverse effects or cost-
effectiveness outcomes. Conclusion: Although the findings were biased by some small positive trials, psychotherapies appear to help depressed youths
for the short term, but are no longer significantly favourable at 6-month follow-up. copyright 2007 The Authors.
Acta Psychiatrica Scandinavica., 116(2) : 84-
95
- Year: 2007
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Trowell, Judith, Joffe, Ilan, Campbell, Jesse, Clemente, Carmen, Almqvist,
Fredrik, Soininen, Mika, Koskenranta-Aalto, Ulla, et-al
BACKGROUND: Although considered
clinically effective, there is little systematic research confirming the use of Individual Psychodynamic Psychotherapy or Family Therapy as
treatments for depression in children and young adolescents. AIMS: A clinical trial assessed the effectiveness of these two forms of psychotherapy in
treating moderate and severe depression in this age group. METHODS: A randomised control trial was conducted with 72 patients aged 9-15 years
allocated to one of two treatment groups. RESULTS: Significant reductions in disorder rates were seen for both Individual Therapy and Family Therapy.
A total of 74.3% of cases were no longer clinically depressed following Individual Therapy and 75.7% of cases were no longer clinically depressed
following Family Therapy. This included cases of Dysthymia and \"Double Depression\" (co-existing Major Depressive Disorder and Dysthymia). There was
also an overall reduction in co-morbid conditions across the study. The changes in both treatment groups were persistent and there was ongoing
improvement. At follow up six months after treatment had ended, 100% of cases in the Individual Therapy group, and 81% of cases in the Family Therapy
group were no longer clinically depressed. CONCLUSIONS: This study provides evidence supporting the use of focused forms of both Individual
Psychodynamic Therapy and Family Therapy for moderate to severe depression in children and young adolescents.
European Child & Adolescent Psychiatry, 16(3) : 157-67
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Interpersonal therapy (IPT)
Moreno, C., Arango, C., Parellada, M., Shaffer, D., Bird, H.
OBJECTIVE: To examine the data on the
effect of antidepressant medication in depressed children and adolescents and the causes of the results obtained. METHOD: A systematic literature
search was conducted, supplemented by a manual search, and a search of public online information on paediatric antidepressant trials reviewed by
regulatory agencies. RESULTS: Data gathered from published and unpublished randomized controlled trials vary in their findings, with most of the
studies showing a lack of efficacy characterized by a high placebo response rate. CONCLUSION: Differences from efficacy results with the same drugs
in adult depression may be because of neurobiological developmental correlates, developmental differences in pharmacokinetics and pharmacodynamics,
high rates of placebo response in children, and a number of methodological influences. There are several areas needing more attention in paediatric
antidepressant clinical trials. Judicious use of published and unpublished studies to assess who may benefit from treatment with antidepressants
seems warranted.
Acta Psychiatrica
Scandinavica, 115(3) : 184-95
- Year: 2007
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any)
Hetrick, S., Merry, S., McKenzie, J., Sindahl, P., Proctor, M.
BACKGROUND: Depressive disorders are common in young people and are associated with significant negative impacts.
Selective serotonin reuptake inhibitors (SSRIs) are often used, however, evidence of their effectiveness in children and adolescents is not clear.
Furthermore, there have been warnings against their use in this population due to concerns about increased risk of suicidal ideation and behaviour.
OBJECTIVES: To determine the efficacy and adverse outcomes, including definitive suicidal behaviour and suicidal ideation, of SSRIs compared to
placebo in the treatment of depressive disorders in children and adolescents. SEARCH STRATEGY: We searched the CCDAN Trials Register, MEDLINE,
PSYCHINFO and CENTRAL. Reference lists were checked, letters were sent to key researchers and internet databases searched. SELECTION CRITERIA: We
included published and unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS: Two or three review authors selected the trials,
assessed the quality and extracted trial and outcome data. We used a fixed-effect meta-analysis. The relative risk was used to summarise dichotomous
outcomes and the mean difference to summarise continuous measures. MAIN RESULTS: Twelve trials were eligible for inclusion, with ten providing usable
data. At 8-12 weeks, there was evidence that children and adolescents 'responded' to treatment with SSRIs (RR 1.28, 95% CI 1.17 to 1.41). There was
also evidence of an increased risk of suicidal ideation and behaviour for those prescribed SSRIs (RR 1.80, 95% CI 1.19 to 2.72). Fluoxetine was the
only SSRI where there was consistent evidence from three trials that it was effective in reducing depression symptoms in both children and
adolescents (CDRS-R treatment effect -5.63, 95% CI -7.38 to -3.88), and 'response' to treatment (RR 1.86, 95% CI 1.49 to 2.32). Where rates of
adverse events were reported, this was higher for those prescribed SSRIs. AUTHORS' CONCLUSIONS: Caution is required to interpret the results. First,
there were methodological issues, including high attrition, issues regarding measurement instruments and clinical usefulness of outcomes, often
variously defined across trials. Second, patients seen in clinical practice are likely to be more unwell, and at greater risk of suicide, compared to
those in the trials, and it is unclear how this group would respond to SSRIs. This needs to be considered, along with the evidence of an increased
risk of suicide related outcomes in those treated with SSRIs. It is unclear what the effect of SSRIs is on suicide completion. While untreated
depression is associated with the risk of completed suicide and impacts on functioning, it is unclear whether SSRIs would modify this risk in a
clinically meaningful way. [References: 127]
Cochrane Database
of Systematic Reviews, (3) : CD004851
- Year: 2007
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Mason, W. A., Kosterman, R., Hawkins, J. D., Haggerty, K. P., Spoth, R. L., Redmond, C.
Preparing for the Drug Free Years (PDFY) is a preventive intervention that targets parenting behaviors, family
interaction patterns, and adolescent substance use, factors that have been shown to predict depression among teenagers. Effects of PDFY on
trajectories of self-reported adolescent depressive symptoms from 6th through 12th grade were examined. Latent growth curve modeling was used to
analyze data from 429 rural adolescents from schools assigned randomly to an intervention or a control condition. PDFY reduced the rate of increase
in depressive symptoms during adolescence. Mediation of the intervention effect on depressive symptoms through reduced polysubstance use was tested;
the indirect effect was only marginally significant. Findings have implications for understanding the relationship between adolescent depressive
symptoms and substance use, and for preventing these outcomes.
, 17(3) : 541-64
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Skills training
Mayes, T. L., Tao, R., Rintelmann, J. W., Carmody, T., Hughes, C. W., Kennard, B. D., Stewart, S.
M., Emslie, G. J.
Objective: Recent acute efficacy trials of anti-depressants in youth have suggested that high
placebo-response rates in children (<12 years of age) indicate that children may be more responsive to non-specific treatment interventions. Yet,
these studies generally have not presented age-specific outcome data. The objective of this study was to compare the efficacy outcomes for children
(<12 years of age) and adolescents ([greater-than or equal to]12 years of age) using the combined data from two previously published double-blind,
placebo-controlled trials of fluoxetine. Methods: Children (<12 years of age) and adolescents ([greater-than or equal to]12 years of age) with major
depressive disorder were randomized to fluoxetine or placebo for 8-9 weeks of treatment. Outcome was assessed using the Children's Depression Rating
Scale-Revised (CDRS-R) and Clinical Global Impressions scale. Results: Random regression of the CDRS-R showed a treatment group by age group
interaction (F1,338=4.10, P=.044), indicating that the treatment effect was significantly more pronounced in children than adolescents.
Within children, response at exit to fluoxetine was significantly better than placebo (56.9% vs 33.3%; P=.009). Adolescent response rates at exit
were not significantly different between the groups (51.1% vs 38.6%; P=.128). Remission rates were low for both groups. Conclusion: In the combined
fluoxetine trials, drug-placebo difference was greater in children compared with adolescents. Contrary to expectations, the placebo-response rate was
lower in the children than the adolescents.
CNS Spectrums., 12(2) : 147-
154
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
March, John S., Silva, Susan, Petrycki, Stephen, Curry, John, Wells, Karen, Fairbank, John, Burns, Barbara, Domino,
Marisa, McNulty, Steven, Vitiello, Benedetto, Severe, Joanne
CONTEXT: The Treatment
for Adolescents With Depression Study evaluates the effectiveness of fluoxetine hydrochloride therapy, cognitive behavior therapy (CBT), and their
combination in adolescents with major depressive disorder. OBJECTIVE: To report effectiveness outcomes across 36 weeks of randomized treatment.
DESIGN AND SETTING: Randomized, controlled trial conducted in 13 academic and community sites in the United States. Cognitive behavior and
combination therapies were not masked, whereas administration of placebo and fluoxetine was double-blind through 12 weeks, after which treatments
were unblinded. Patients assigned to placebo were treated openly after week 12, and the placebo group is not included in these analyses by design.
PARTICIPANTS: Three hundred twenty-seven patients aged 12 to 17 years with a primary DSM-IV diagnosis of major depressive disorder. INTERVENTIONS:
All treatments were administered per protocol. MAIN OUTCOME MEASURES: The primary dependent measures rated blind to treatment status by an
independent evaluator were the Children's Depression Rating Scale-Revised total score and the response rate, defined as a Clinical Global
Impressions-Improvement score of much or very much improved. RESULTS: Intention-to-treat analyses on the Children's Depression Rating Scale-Revised
identified a significant time x treatment interaction (P < .001). Rates of response were 73% for combination therapy, 62% for fluoxetine therapy, and
48% for CBT at week 12; 85% for combination therapy, 69% for fluoxetine therapy, and 65% for CBT at week 18; and 86% for combination therapy, 81% for
fluoxetine therapy, and 81% for CBT at week 36. Suicidal ideation decreased with treatment, but less so with fluoxetine therapy than with combination
therapy or CBT. Suicidal events were more common in patients receiving fluoxetine therapy (14.7%) than combination therapy (8.4%) or CBT (6.3%).
CONCLUSIONS: In adolescents with moderate to severe depression, treatment with fluoxetine alone or in combination with CBT accelerates the response.
Adding CBT to medication enhances the safety of medication. Taking benefits and harms into account, combined treatment appears superior to either
monotherapy as a treatment for major depression in adolescents.
Archives of
General Psychiatry, 64(10) : 1132-43
- Year: 2007
- 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: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)