Disorders - depressive disorders
Weisz, John R., McCarty,
Carolyn A., Valeri, Sylvia M.
Serious sequelae of youth depression, plus recent concerns over medication
safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above
conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest
study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g.,
cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity
(externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are
significant but modest in their strength, breadth, and durability.
Psychological Bulletin, 132(1) : 132-
49
- Year: 2006
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any)
Verdeli, H., Mufson, L., Lee, L., Keith, J. A.
Aim: To review the literature on randomized clinical trials for pediatric
anxiety and depression, and evaluate their quality using the criteria developed by the American Psychological Association. Method: Inclusion of
randomized controlled clinical trials in the medical and psychological literature. Results: Research evidence thus far suggests that CBT is a
probably efficacious treatment for depression in children. None of the CBT protocols for depressed adolescents (taken independently) meet criteria
for a well-established treatment, however, if the different protocols are taken as an aggregate, then CBT meets well-established treatment criteria.
In addition, IPT-A is a well-established treatment for adolescent depression. CBT is the best established treatment for a number of child and
adolescent anxiety disorders. Conclusion: While there has been an increase in the number of clinical trials of psychotherapeutic interventions for
depression and anxiety as well as support for empirically-based treatments, the scope of these studies is still limited and research is still needed
to examine the transportability of these treatments to diverse community settings. copyright 2006 Bentham Science Publishers Ltd.
Current Psychiatry Reviews., 2(3) : 395-
421
- Year: 2006
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any)
Wallace, Amy E., Neily, Julia, Weeks, William B., Friedman, Matthew J.
OBJECTIVE: The aim of this
study was to assess whether unpublished trials of serotonin reuptake inhibitors in pediatric depression impacted efficacy or safety conclusions, and
to examine the evolution of information contributing to the safety/efficacy debate. METHOD: From 939 potentially relevant studies extracted from
Medline, Cinahl, Biosis, and Cochrane databases, and from the United Kingdom's Committee on Safety of Medicines website, we examined 38 studies: Ten
published and five unpublished randomized, controlled trials, 22 observational studies, and one crossover trial. We performed cumulative and non-
cumulative meta-analyses and generated pooled relative rates of response and serious adverse events for high-quality randomized, controlled trials.
RESULTS: Unpublished studies did not substantially alter the risk-to-benefit determination. Cumulative meta-analyses of seven randomized, controlled
trials for efficacy and 11 randomized, controlled trials for safety suggest an adverse safety/efficacy profile for selective serotonin reuptake
inhibitors (SSRIs) overall. Fluoxetine and citalopram appear to offer favorable risk to benefit profiles, while shorter-acting agents pose greater
risks and provide marginal benefit. CONCLUSIONS: While simple meta-analysis across all SSRIs for treatment of pediatric depression provided general
efficacy and safety information, meta-analysis of individual drugs and use of cumulative meta-analytic techniques may have expedited our ability to
formulate conclusions about safety and efficacy of SSRIs in pediatric depression.
Journal of Child & Adolescent
Psychopharmacology, 16(1-2) : 37-58
- Year: 2006
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Stein,
Ruth E. K., Zitner, Lauren E., Jensen, Peter S.
BACKGROUND: Depression in adolescents is underrecognized and undertreated despite
its poor long-term outcomes, including risk for suicide. Primary care settings may be critical venues for the identification of depression, but there
is little information about the usefulness of primary care interventions. OBJECTIVE: We sought to examine the evidence for the treatment of
depression in primary care settings, focusing on evidence concerning psychosocial, educational, and/or supportive intervention strategies. METHODS:
Available data on brief psychosocial treatments for adolescent depression in primary settings were reviewed. Given the paucity of direct studies, we
also drew on related literature to summarize available evidence whether brief, psychosocial support from a member of the primary care team, with or
without medication, might improve depression outcomes. RESULTS: We identified 37 studies relevant to treating adolescent depression in primary care
settings. Only 4 studies directly examined the impact of primary care-delivered psychosocial interventions for adolescent depression, but they
suggest that such interventions can be effective. Indirect evidence from other psychosocial/behavioral interventions, including anticipatory guidance
and efforts to enhance treatment adherence, and adult depression studies also show benefits of primary care-delivered interventions as well as the
impact of provider training to enhance psychosocial skills. CONCLUSIONS: There is potential for successful treatment of adolescent depression in
primary care, in view of evidence that brief, psychosocial support, with or without medication, has been shown to improve a range of outcomes,
including adolescent depression itself. Given the great public health problem posed by adolescent depression, the likelihood that most depressed
adolescents will not receive specialty services, and new guidelines for managing adolescent depression in primary care, clinicians may usefully
consider initiation of supportive interventions in their primary care practices. [References: 76]
Pediatrics, 118(2) : 669-
82
- Year: 2006
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Young, Jami F., Mufson, Laura, Davies, Mark
OBJECTIVE: To assess the impact of comorbid anxiety on treatment for adolescent depression in an effectiveness study of
interpersonal psychotherapy for depressed adolescents (IPT-A). METHOD: A randomized clinical trial was conducted from April 1, 1999, through July 31,
2002. Sixty-three depressed adolescents, ages 12 to 18, received either IPT-A or treatment as usual delivered by school-based mental health
clinicians. Adolescents with and without probable comorbid anxiety disorders were compared on depression and overall functioning. All analyses used
an intent-to-treat design. RESULTS: Comorbid anxiety was associated with higher depression scores at baseline (p <.01) and poorer depression outcome
posttreatment (p <.05). IPT-A was nonsignificantly more effective in treating the depression of adolescents with comorbid anxiety (p =.07).
Adolescents whose depression and functioning improved during the course of treatment also showed an improvement in anxiety (p <.01), largely
irrespective of treatment condition. CONCLUSIONS: Adolescents with comorbid depression and anxiety present with more severe depression and may be
more difficult to treat. Structured treatments like IPT-A may be particularly helpful for comorbidly depressed adolescents as compared to supportive
therapy.
Journal of the American Academy of Child & Adolescent
Psychiatry, 45(8) : 904-12
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Interpersonal therapy (IPT)
Young, Jami F., Mufson, Laura, Davies, Mark
BACKGROUND: Indicated interventions
for adolescents with elevated depressive symptoms may help decrease rates of depression. The current study reports on the efficacy of Interpersonal
Psychotherapy-Adolescent Skills Training (IPT-AST), a group indicated preventive intervention. METHODS: Forty-one adolescents with elevated
depression symptoms were randomized to receive either IPT-AST or school counseling (SC) as delivered by guidance counselors and social workers.
Adolescents in the two intervention conditions were compared on depression symptoms, overall functioning, and depression diagnoses post-intervention
and at 3-month and 6-month follow-up. RESULTS: Adolescents who received IPT-AST had significantly fewer depression symptoms and better overall
functioning post-intervention and at follow-up. Adolescents in IPT-AST also reported fewer depression diagnoses than adolescents in usual care.
CONCLUSIONS: These results provide preliminary evidence of the efficacy of IPT-AST as an intervention for adolescents with subthreshold depression.
Future research is needed to confirm the efficacy of IPT-AST in a larger and more diverse sample and to determine its long-term impact on depression
symptoms and depression diagnoses.
Journal of Child Psychology & Psychiatry & Allied Disciplines, 47(12) : 1254-
62
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Interpersonal therapy (IPT), Skills training, Other Psychological Interventions
Wagner, Karen Dineen, Jonas,
Jeffrey, Findling, Robert L., Ventura, Daniel, Saikali, Khalil
OBJECTIVE: Escitalopram is a selective serotonin reuptake inhibitor antidepressant indicated for use
in adults. This trial examined the efficacy and safety of escitalopram in pediatric depression. METHOD: Patients (6-17 years old) with major
depressive disorder were randomized to receive 8 weeks of double-blind flexibly dosed treatment with escitalopram (10-20 mg/day; n = 131) or placebo
(n = 133). Randomization was not stratified by age. The primary efficacy measure was the mean change from baseline to endpoint in Children's
Depression Rating Scale-Revised (CDRS-R) scores, using the last observation carried forward approach. RESULTS: A total of 82% of patients completed
treatment. Escitalopram did not significantly improve CDRS-R scores compared to placebo at endpoint (least squares mean difference = -1.7, p = .31;
last observation carried forward). In a post hoc analysis of adolescent (ages 12-17 years) completers, escitalopram significantly improved CDRS-R
scores compared with placebo (least squares mean difference = -4.6, p = .047). Headache and abdominal pain were the only adverse events in >10% of
patients in the escitalopram group. Discontinuation rates caused by adverse events were 1.5% for both groups. Potential suicide-related events were
observed in one escitalopram- and two placebo-treated patients. There were no completed suicides. CONCLUSIONS: Although there were no significant
differences between escitalopram and placebo in the total population, the data suggest that escitalopram may have beneficial effects in adolescent
patients. Escitalopram appeared to be well tolerated.
Journal
of the American Academy of Child & Adolescent Psychiatry, 45(3) : 280-8
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Von Knorring, A. L., Olsson, G. I., Thomsen, P. H., Lemming, O. M., Hulten, A.
In a European, multicenter, double-blind study, 244 adolescents, 13 to 18 years old, with
major depression were randomized to treatment with citalopram (n = 124) or placebo (n = 120). One third of the patients in both groups withdrew from
the study. No significant differences in improvement of scores from baseline to week 12 between citalopram and placebo were found. The response rate
was 59% to 61% in both groups according to the Schedule for Affective Disorders and Schizophrenia for school-aged children-Present episode version
(Kiddie-SADS-P) (depression and anhedonia scores [less-than or equal to]2) and Montgomery Asberg Depression Rating Scale (MADRS) ([greater-than or
equal to]50% reduction). Remission (MADRS score [less-than or equal to]12) was achieved by 51% of patients with citalopram and 53% with placebo. A
post hoc analysis revealed that more than two thirds of all patients received psychotherapy during this study. For those patients not receiving
psychotherapy, there was a higher percentage of Kiddie-SADS-P responders with citalopram (41%) versus placebo (25%) and a significantly higher
percentage of MADRS responders and remitters with citalopram (52% and 45%, respectively) versus placebo (22% and 19%, respectively). Mild to moderate
treatment-emergent adverse events were reported in 75% citalopram and 71% of placebo patients, most commonly headache, nausea, and insomnia. Serious
adverse events occurred in 14% to 15% in both groups. Suicide attempts, including suicidal thoughts and tendencies, were reported by 5 patients in
the placebo group and by 14 patients in the citalopram group (not significant) with no pattern with respect to duration of treatment, time of onset,
or dosage. In contrast, the suicidal ideation (Kiddie-SADS-P) single item showed worsening more frequently in the placebo (18%) than in the
citalopram group (8%). Copyright copyright 2006 by Lippincott Williams & Wilkins.
Journal of Clinical
Psychopharmacology, 26(3) : 311-315
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Sharp, Susan C., Hellings, Jessica A.
BACKGROUND: Given the widespread reports involving the use of selective serotonin reuptake
inhibitors (SSRIs) in children, the present paper reviews and discusses published double-blind, placebo-controlled studies assessing the safety and
efficacy of SSRIs in children and adolescents with major depressive disorder. METHODS: Published and unpublished double-blind, placebo-controlled
studies of SSRIs in children and adolescents with depression during the years 1990-2004 were reviewed. A MEDLINE search was performed using the words
'depression', 'randomised controlled trial', 'SSRIs', 'children' and 'adolescents'. The GlaxoSmithKline website was also searched for
relevant studies on paroxetine. Outcome measures were the Clinical Global Impressions scale, the Children's Depression Rating Scale-Revised, the
Hamilton Rating Scale for Depression, the depression subscales of the Kiddie Schedule for Affective Disorders and Schizophrenia for Adolescents-
Lifetime version, and the Montgomery and Asberg Depression Rating Scale. Adverse effects and withdrawal rates are reported. RESULTS: There were seven
randomised, placebo-controlled trials involving 1619 children and adolescents aged 6-18 years in total. The SSRIs fluoxetine, paroxetine, sertraline
and citalopram were reported to exhibit safety and efficacy for treatment of depression in children and adolescents. Reanalysis of published and
unpublished studies by the US FDA and the UK's Medicines and Healthcare products Regulatory Agency (MHRA) raised alerts regarding higher suicidal
ideation rates from SSRIs in this population. Present guidelines are discussed. CONCLUSIONS: SSRIs remain a first-line pharmacological treatment for
depression in children and adolescents for whom psychotherapy has failed or is unavailable. Suicidal ideation and behaviours merit close monitoring.
More studies are needed.
Clinical Drug Investigation, 26(5) : 247-
55
- Year: 2006
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Sheffield, Jeanie K., Spence, Susan H., Rapee, Ronald M., Kowalenko, Nick, Wignall, Ann, Davis, Anna, McLoone, Jordana
A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and
combined universal plus indicated cognitive- behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting
elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on
changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of
condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated
elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention
effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions. Copyright (c) 2006
APA, all rights reserved.
Journal of Consulting & Clinical
Psychology, 74(1) : 66-79
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Seligman, Martin E. P., Rashid, Tayyab, Parks,
Acacia C.
Positive psychotherapy (PPT)
contrasts with standard interventions for depression by increasing positive emotion, engagement, and meaning rather than directly targeting
depressive symptoms. The authors have tested the effects of these interventions in a variety of settings. In informal student and clinical settings,
people not uncommonly reported them to be \"life-changing.\" Delivered on the Web, positive psychology exercises relieved depressive symptoms for at
least 6 months compared with placebo interventions, the effects of which lasted less than a week. In severe depression, the effects of these Web
exercises were particularly striking. This address reports two preliminary studies: In the first, PPT delivered to groups significantly decreased
levels of mild-to-moderate depression through 1-year follow-up. In the second, PPT delivered to individuals produced higher remission rates than did
treatment as usual and treatment as usual plus medication among outpatients with major depressive disorder. Together, these studies suggest that
treatments for depression may usefully be supplemented by exercises that explicitly increase positive emotion, engagement, and meaning. ((c) 2006
APA, all rights reserved).
American Psychologist, 61(8) : 774-
88
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Positive
psychology
Rohde, P, Seeley, J. R., Clarke, G. N., Kaufman, N. K., Stice, E.
Aims were to identify the demographic, psychopathology, and psychosocial factors predicting time to major depressive
disorder (MDD) recovery and moderators of treatment among 114 depressed adolescents recruited from a juvenile justice center and randomized to a
cognitive-behavioral treatment (CBT) condition or a life skills-tutoring control condition. Nine variables predicted time to recovery over 1-year
follow-up (e.g., earlier MDD onset, attention-deficit/hyperactivity disorder, functional impairment, hopelessness, negative thoughts, low family
cohesion, coping skills); suicidal ideation and parental report of problem behaviors were the best predictors. CBT resulted in faster recovery time
relative to control treatment, specifically among adolescents of White ethnicity, with recurrent MDD, and with good coping skills. Results suggest
that psychopathology plays a more prominent role in maintaining adolescent depression than demographic or psychosocial factors.
Journal of Consulting & Clinical Psychology, 74(1) : 80-8
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Skills training