Compton, Scott N., March, John S., Brent, David, Albano, Anne Marie, Weersing, Robin, Curry, John

Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review.[see comment]

OBJECTIVE: To review the literature on the cognitive-behavioral treatment of children and adolescents with anxiety and depressive disorders within the conceptual framework of evidence-based medicine. METHOD: The psychiatric and psychological literature was systematically searched for controlled trials applying cognitive-behavioral treatment to pediatric anxiety and depressive disorders. RESULTS: For both anxiety and depression, substantial evidence supports the efficacy of problem-specific cognitive-behavioral interventions. Comparisons with wait-list, inactive control, and active control conditions suggest medium to large effects for symptom reduction in primary outcome domains. CONCLUSIONS: From an evidence-based perspective, cognitive-behavioral therapy is currently the treatment of choice for anxiety and depressive disorders in children and adolescents. Future research in this area will need to focus on comparing cognitive-behavioral psychotherapy with other treatments, component analyses, and the application of exportable protocol-driven treatments to divergent settings and patient populations. [References: 80]

Journal of the American Academy of Child & Adolescent Psychiatry, 43(8) : 930- 59

Hritzak, K., Culhane, N. S.

Sertraline effective for children and adolescents with major depression

Journal of Family Practice., 53(1) : 11- 12

Possel, Patrick, Horn, Andrea B., Groen, Gunter, Hautzinger, Martin

School-based prevention of depressive symptoms in adolescents: A 6-month follow-up

OBJECTIVE: Depressive disorders in adolescents are a widespread problem with extensive psychosocial consequences. The authors designed a school-based program to prevent the increase in depressive symptoms. The authors expect the program to reduce dysfunctional automatic thoughts and improve social skills and thus prevent the increase in depressive symptoms. METHOD: The design includes a training group and a nontreatment control group with pre- and post- measurement and 3- and 6-month follow-up. The authors followed up 324 eighth graders in both groups. School classes were randomly assigned to one of the two groups. The prevention program, LISA-T, is based on cognitive-behavioral therapy concepts and targets of cognitive and social aspects. It comprises 10 meetings of 1.5 hours in a regular school setting. RESULTS: Increases in depressive symptoms in nondepressed adolescents in the training group were prevented over a 6-month period. Furthermore, adolescents with subsyndromal depression in the training group reported fewer symptoms, whereas depressive symptoms within the control group did not change. However, the groups did not differ with regard to social skills, frequency of negative automatic thoughts, and depressive symptoms before the prevention program. CONCLUSIONS: LISA-T is an effective school-based prevention program for eighth graders with minimal to mild depressive symptoms, but further research is needed.

Journal of the American Academy of Child & Adolescent Psychiatry, 43(8) : 1003-10

Mufson, Laura, Dorta, Kristen Pollack, Wickramaratne, Priya, Nomura, Yofeo, Olfson, Mark, Myrna, M.

A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents

Assessed the effectiveness of interpersonal psychotherapy modified for depressed adolescents (IPT-A) compared with treatment as usual (TAU) in school-based mental health clinics. Subjects included 63 adolescents (mean age 15.1 yrs) referred for a mental health intake visit who met eligibility criteria. Eligible patients had a mean Hamilton Depression Rating Scale score of 18.6 and a mean Children's Global Assessment Scale score of 52.6 and met DSM-IV criteria for major depressive disorder, dysthymia, depression disorder not otherwise specified, or adjustment disorder with depressed mood. Adolescents treated with IPT-A compared with TAU showed greater symptom reduction and improvement in overall functioning. Analysis of covariance showed that compared with the TAU group, the IPT-A group showed significantly fewer clinician-reported depression symptoms on the Hamilton Depression Rating Scale (P=.04), significantly better functioning on the Children's Global Assessment Scale (P=.04), significantly better overall social functioning on the Social Adjustment Scale-Self-Report (P=.01), significantly greater clinical improvement (P=.03), and significantly greater decrease in clinical severity (P=.03) on the Clinical Global Impressions scale. (PsycINFO Database Record (c) 2007 APA, all rights reserved).

Archives of General Psychiatry, 61(6) : 577-584

Kerfoot, Michael, Harrington, Richard, Harrington, Val, Rogers, Julia, Verduyn, Chrissie

A step too far? Randomized trial of cognitive-behaviour therapy delivered by social workers to depressed adolescents

OBJECTIVE: To test the hypothesis that depressed adolescents given brief cognitive behaviour therapy by trained social workers will be less depressed after this treatment than depressed adolescents who have routine care from their social workers. METHOD: Open study, two randomized parallel groups. 86 social workers were randomized to training in brief CBT or delayed training by remote telephone randomization. 25 social workers who attended CBT training recruited 29 depressed adolescents. 22 social workers in the control group recruited 23 depressed adolescents. RESULTS: Social workers' perceptions of their knowledge and skills in dealing with adolescent depression were better after the training than before. However, in intention to treat analyses, adolescents who had therapy from trained social workers had a similar level of depression post treatment (mean depression score 17.5, 95% CI 11.8 to 23.3) to those who did not have such therapy (mean depression score 16.7, 95 % CI 11.3 to 22.1). There were no significant differences between the groups on other outcomes or at follow-up. CONCLUSIONS: This study failed to recruit enough cases and probably did not therefore have enough statistical power to detect an effect of the intervention. It was also based on a severely impaired sample with many comorbid problems. However, the results suggest that training community-based social workers in cognitive behaviour therapy is neither practical nor effective in improving the outcomes of their clients.

European Child & Adolescent Psychiatry, 13(2) : 92-9

Roberts, Clare, Kane, Robert, Bishop, Brian, Matthews, Heather, Thomson, Helen

The prevention of depressive symptoms in rural school children: A follow-up study

This study investigated the long-term effects of the Penn Prevention Program in preventing depressive and anxious symptoms in Australian rural school children with elevated levels of depressive symptoms, at 18- and 30- month follow-up. Seventh grade students from nine primary schools (n = 90) were randomly assigned to receive the programme and nine control schools (n = 99) received their usual health education classes and symptom monitoring. A no-intervention comparison group (n = 114) from 18 rural primary schools matched to the intervention and control group schools received their usual health education classes and were assessed at pre-intervention and 30- month follow-up. Students completed questionnaires on depression, anxiety, explanatory style and social skills. Parents completed the Child Behavior Checklist. No intervention effects were found for any child-report or parent-report variables at the 18-month follow-up. At the 30-month follow-up, intervention group children reported less anxiety than control or comparison groups. However, there were no effects for depression. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract).

International Journal of Mental Health Promotion, 6(3) : 4- 16

Rohde, Paul, Clarke, Gregory N., Mace, David E., Jorgensen, Jenel S., Seeley, John R.

An efficacy/effectiveness study of cognitive- behavioral treatment for adolescents with comorbid major depression and conduct disorder

OBJECTIVE: To evaluate effectiveness of the Adolescent Coping With Depression (CWD-A) course, a cognitive-behavioral group intervention for depressed adolescents with comorbid conduct disorder. METHOD: Between 1998 and 2001, 93 nonincarcerated adolescents (ages 13-17 years) meeting criteria for major depressive disorder and conduct disorder were recruited from a county juvenile justice department and randomly assigned to the CWD-A or a life skills/tutoring control condition. Participants were assessed post-treatment and at 6- and 12-month follow-up. Dichotomous outcomes were analyzed with logistic regression; dimensional measures were analyzed using random effects regression. RESULTS: Major depressive disorder recovery rates post-treatment were greater in CWD-A (39%) compared with life skills/tutoring control (19%) (odds ratio 2.66, 95% confidence interval = 1.03-6.85). CWD-A participants reported greater reductions in Beck Depression Inventory-II (r2 = 0.055, p =.033) and Hamilton Depression Rating Scale (r2 = 0.047, p =.039) scores and improved social functioning (r2 = 0.064, p =.019) post-treatment. Group differences in major depressive disorder recovery rates at 6- and 12-month follow-up were nonsignificant, as were differences in conduct disorder both post-treatment and during follow-up. CONCLUSIONS: This is the first randomized, controlled trial of a psychosocial intervention with adolescents with major depressive disorder and conduct disorder. Although the CWD-A appears to be an effective acute treatment for depression in adolescents with multiple disorders, findings emphasize the need to improve long-term outcomes for depressed adolescents with psychiatric comorbidity and imply that interventions for comorbid populations focus directly on each specific disorder.

Journal of the American Academy of Child & Adolescent Psychiatry, 43(6) : 660-8

Wagner, Karen Dineen, Robb, Adelaide S., Findling, Robert L., Jin, Jianqing, Gutierrez, Marcelo M., Heydorn, William E.

A randomized, placebo-controlled trial of citalopram for the treatment of major depression in children and adolescents.[see comment]

OBJECTIVE: Open-label trials with the selective serotonin reuptake inhibitor citalopram suggest that this agent is effective and safe for the treatment of depressive symptoms in children and adolescents. The current study investigated the efficacy and safety of citalopram compared with placebo in the treatment of pediatric patients with major depression. METHOD: An 8-week, randomized, double-blind, placebo-controlled study compared the safety and efficacy of citalopram with placebo in the treatment of children (ages 7-11) and adolescents (ages 12-17) with major depressive disorder. Diagnosis was established with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Patients (N=174) were treated initially with placebo or 20 mg/day of citalopram, with an option to increase the dose to 40 mg/day at week 4 if clinically indicated. The primary outcome measure was score on the Children's Depression Rating Scale-Revised; the response criterion was defined as a score of < or =28. RESULTS: The overall mean citalopram dose was approximately 24 mg/day. Mean Children's Depression Rating Scale- Revised scores decreased significantly more from baseline in the citalopram treatment group than in the placebo treatment group, beginning at week 1 and continuing at every observation point to the end of the study (effect size=2.9). The difference in response rate at week 8 between placebo (24%) and citalopram (36%) also was statistically significant. Citalopram treatment was well tolerated. Rates of discontinuation due to adverse events were comparable in the placebo and citalopram groups (5.9% versus 5.6%, respectively). Rhinitis, nausea, and abdominal pain were the only adverse events to occur with a frequency exceeding 10% in either treatment group. CONCLUSIONS: In this population of children and adolescents, treatment with citalopram reduced depressive symptoms to a significantly greater extent than placebo treatment and was well tolerated.

American Journal of Psychiatry, 161(6) : 1079- 83

Williams, A., Hagerty, B. M., Yousha, S. M., Horrocks, J., Hoyle, K. S., Liu, D.

Psychosocial effects of the boot strap intervention in navy recruits

The purpose of this prospective study was to investigate the effects of the Boot Camp Survival Training for Navy Recruits-A Prescription (BOOT STRAP) intervention on stress, depression, situational events, interpersonal factors, and recruit training performance. Divisions of Navy recruits were randomly selected and 801 recruits participated for the 9 weeks of their training. Recruits \"at risk\" for depression were randomly assigned to the intervention or nonintervention groups, and the remaining recruits served as the comparison group. The at-risk recruits who received the BOOT STRAP intervention significantly increased their sense of belonging, experienced less loneliness, used more problem-solving coping skills, and decreased insecure attachment by the end of recruit training. Percentages of recruits in the study successfully completing basic training were 84% of the comparison group, 86% of the intervention group, and only 74% of the nonintervention group. Results suggest that the BOOT STRAP intervention improves recruit functioning, strengthens training performance, helps reduce attrition, and may have important implications for stress and depression interventions. Copyright copyright by Association of Military Surgeons of U.S., 2004.

Military Medicine., 169(10) : 814-820

Whittington, Craig J., Kendall, Tim, Fonagy, Peter, Cottrell, David, Cotgrove, Andrew, Boddington, Ellen

Selective serotonin reuptake inhibitors in childhood depression: Systematic review of published versus unpublished data.[see comment]

BACKGROUND: Questions concerning the safety of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression in children led us to compare and contrast published and unpublished data on the risks and benefits of these drugs. METHODS: We did a meta-analysis of data from randomised controlled trials that evaluated an SSRI versus placebo in participants aged 5-18 years and that were published in a peer- reviewed journal or were unpublished and included in a review by the Committee on Safety of Medicines. The following outcomes were included: remission, response to treatment, depressive symptom scores, serious adverse events, suicide-related behaviours, and discontinuation of treatment because of adverse events. FINDINGS: Data for two published trials suggest that fluoxetine has a favourable risk-benefit profile, and unpublished data lend support to this finding. Published results from one trial of paroxetine and two trials of sertraline suggest equivocal or weak positive risk-benefit profiles. However, in both cases, addition of unpublished data indicates that risks outweigh benefits. Data from unpublished trials of citalopram and venlafaxine show unfavourable risk-benefit profiles. INTERPRETATION: Published data suggest a favourable risk-benefit profile for some SSRIs; however, addition of unpublished data indicates that risks could outweigh benefits of these drugs (except fluoxetine) to treat depression in children and young people. Clinical guideline development and clinical decisions about treatment are largely dependent on an evidence base published in peer-reviewed journals. Non-publication of trials, for whatever reason, or the omission of important data from published trials, can lead to erroneous recommendations for treatment. Greater openness and transparency with respect to all intervention studies is needed. [References: 29]

Lancet, 363(9418) : 1341-5

Weisz, John R., Hawley, Kristin M., Doss, Amanda Jensen

Empirically tested psychotherapies for youth internalizing and externalizing problems and disorders

This article is a review of specific psychotherapies that have been supported in clinical trials. Treatments that showed significant effects in studies published over a period of 4 decades were identified, with the goal of complementing the overall picture of treatment benefit provided in narrative reviews and meta-analyses with a detailing of the specific interventions that have shown significant effects. The article focuses on treatments for four broad clusters of problems and disorders that account for a very large proportion of youth mental health referrals: anxiety, depression, attention-deficit/hyperactivity, and conduct. [References: 336]

Child & Adolescent Psychiatric Clinics of North America, 13(4) : 729- 815

Wagner, Karen Dineen, Ambrosini, Paul, Rynn, Moira, Wohlberg, Christopher, Yang, Ruoyong, Greenbaum, Michael S., Childress, Ann, Donnelly, Craig, Deas, Deborah, SertralinePediatricDepressionStudyGroup

Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder: Two randomized controlled trials.[see comment]

CONTEXT: The efficacy, safety, and tolerability of selective serotonin reuptake inhibitors (SSRIs) in the treatment of adults with major depressive disorder (MDD) are well established. Comparatively few data are available on the effects of SSRIs in depressed children and adolescents. OBJECTIVE: To evaluate the efficacy and safety of sertraline compared with placebo in treatment of pediatric patients with MDD. DESIGN AND SETTING: Two multicenter randomized, double-blind, placebo-controlled trials were conducted at 53 hospital, general practice, and academic centers in the United States, India, Canada, Costa Rica, and Mexico between December 1999 and May 2001 and were pooled a priori. PARTICIPANTS: Three hundred seventy-six children and adolescents aged 6 to 17 years with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined MDD of at least moderate severity. INTERVENTION: Patients were randomly assigned to receive a flexible dosage (50- 200 mg/d) of sertraline (n = 189) or matching placebo tablets (n = 187) for 10 weeks. MAIN OUTCOME MEASURES: Change from baseline in the Children's Depression Rating Scale-Revised (CDRS-R) Best Description of Child total score and reported adverse events. RESULTS: Sertraline-treated patients experienced statistically significantly greater improvement than placebo patients on the CDRS-R total score (mean change at week 10, -30.24 vs - 25.83, respectively; P =.001; overall mean change, -22.84 vs -20.19, respectively; P =.007). Based on a 40% decrease in the adjusted CDRS-R total score at study end point, 69% of sertraline-treated patients compared with 59% of placebo patients were considered responders (P =.05). Sertraline treatment was generally well tolerated. Seventeen sertraline-treated patients (9%) and 5 placebo patients (3%) prematurely discontinued the study because of adverse events. Adverse events that occurred in at least 5% of sertraline-treated patients and with an incidence of at least twice that in placebo patients included diarrhea, vomiting, anorexia, and agitation. CONCLUSION: The results of this pooled analysis demonstrate that sertraline is an effective and well-tolerated short-term treatment for children and adolescents with MDD.

JAMA, 290(8) : 1033-41