McMillan, L., Owen, L., Kras, M., Scholey, A.

Behavioural effects of a 10-day Mediterranean diet. Results from a pilot study evaluating mood and cognitive performance

There are surprisingly few randomised, controlled trials into the effects of dietary change on mood and cognition in healthy individuals. Here we examined the effects of 10 days of changing to a nutrient-rich diet on mood and cognitive performance. Young female adults (N = 25) were randomised to a diet change (DC), or a no change (NC) control group. Those in the DC condition adhered to the nutrient-dense Mediterranean diet. Mood and cognitive performance were assessed at baseline and on day 10. Compared with the NC group, the DC group showed significant improvements in self-rated vigour, alertness and contentment. Changes in cognitive tasks were somewhat inconsistent. These preliminary findings require verification in larger trials but suggest that appropriate dietary change may benefit mood and some aspects of cognitive performance in healthy adults. All rights reserved, Elsevier.

Appetite, 56(1) : 143-147

McNamara, R. K., Adler, C., Strawn, J., Strimpfel, J., Weber, W., Chu, W. J., Jandacek, R., Rider, T., Tso, P., Strakowski, S. M., DelBello, M. P.

Adolescents with major depressive disorder exhibit reversible erythrocyte docosahexaenoic acid deficits: Associations with depression symptom severity and cortical 1H MRI metabolite concentrations (Conference abstract)

Background: Adults with major depressive disorder (MDD) exhibit deficits in erythrocyte long-chain omega-3 (n-3) fatty acid composition. However, there is currently little known about the n-3 fatty acid status of adolescents with MDD, or the relationships between long-chain n-3 fatty acid supplementation and changes in symptom severity and brain neurochemistry. Methods: Erythrocyte fatty acid composition was determined in adolescents (10-20 years) meeting DSM-IV criteria for MDD (n=20) and healthy adolescents (n=20). Patients were randomized to one of two doses of fish oil (2.4 or 15 g/d) for 10 weeks. At baseline and endpoint, depression symptom severity (CDRS-R) and cortical 1H MRS metabolite (ml, Cho, Cr, NAA, Glx) concentrations were determined. Results: Compared with healthy adolescents, docosahexaenoic acid (DHA, 22:6n-3), the principal n-3 fatty acid in erythrocyte and cortical membranes, was significantly lower in adolescents with MDD (-26%, p = 0.004). The n-3 fatty acid eicosapentaneoic acid (20:5n-3) and n-6 fatty acid arachidonic acid (AA, 20:4n-6) did not differ between groups. Fish oil supplementation significantly increased erythrocyte DHA composition in low-dose (+49%, p<0.0001) and high-dose (+52%, p = 0.0001) groups at 10 weeks. Baseline CDRS total scores declined significantly in low-dose (-18%, p=0.01) and high-dose (-38%, p<0.0001) groups at 10 weeks. There were no significant baselineendpoint changes in metabolite concentrations in right or left dorsolateral prefrontal cortex or anterior cingulate. Conclusions: Adolescent MDD is associated with erythrocyte DHA deficits, and dietary-induced elevations in erythrocyte DHA levels are associated with reductions in depression symptom severity independent of changes in cortical 1H MRS metabolite concentrations.

Biological Psychiatry, 69(9) : 276S

Maalouf, F. T., Atwi, M., Brent, D. A.

Treatment-resistant depression in adolescents: Review and updates on clinical management

Treatment-resistant depression (TRD) in adolescents is prevalent and impairing. We here review the definition, prevalence, clinical significance, risk factors, and management of TRD in adolescents. Risk factors associated with TRD include characteristics of depression (severity, level of hopelessness, and suicidal ideation), psychiatric and medical comorbidities, environmental factors (family conflict, maternal depression, and history of abuse), and pharmacokinetics and other biomarkers. Management options include review of the adequacy of the initial treatment, re- assessment for the above-noted factors that might predispose to treatment resistance, switching antidepressants, and augmentation with medication or psychotherapy. Other modalities, such as electroconvulsive therapy, vagal nerve stimulation, and repetitive transcranial magnetic stimulation, are also reviewed. Depression and Anxiety, 2011. (copyright) 2011 Wiley Periodicals, Inc. (copyright) 2011 Wiley Periodicals, Inc.

Depression & Anxiety, 28(11) : 946-954

Midgley, N., Kennedy, E.

Psychodynamic psychotherapy for children and adolescents: A critical review of the evidence base

For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of 'empirically supported treatments'. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration. (copyright) 2011 Copyright Taylor and Francis Group, LLC.

Journal of Child Psychotherapy, 37(3) : 232-260

Merry, S. N., Hetrick, S. E., Cox, G. R., Bir, J. J., McDowell, H.

Psychological and educational interventions for preventing depression in children and adolescents

Background Depression is common in young people, has amarked negative impact and is associated with self-harmand suicide. Preventing its onset would be an important advance in public health.\rObjectives To determine whether psychological or educational interventions, or both, are effective in preventing the onset of depressive disorder in children and adolescents.\rSearch methods The Cochrane Depression, Anxiety and Neurosis Review Group's trials registers (CCDANCTR) were searched at the editorial base in July 2010. Update searches of MEDLINE, EMBASE, PsycINFO and ERIC were conducted by the authors in September 2009.\rConference abstracts, reference lists of included studies and reviews were searched and experts in the field contacted. \rSelection criteria Randomised controlled trials of psychological or educational prevention programmes, or both, compared with placebo, any comparison intervention, or no intervention for young people aged 5 to 19 years-old, who did not currently meet diagnostic criteria for depression or who were below the clinical range on standardised, validated, and reliable rating scales of depression, or both, were included. \rData collection and analysis Two authors independently assessed studies for inclusion and rated their quality. Sample sizes were adjusted to take account of cluster designs and multiple comparisons. We contacted study authors for additional information where needed.\rMain results Fifty-three studies including 14,406 participants were included in the analysis. There were only six studies with clear allocation concealment, participants and assessors were mostly not blind to the intervention or blinding was unclear so that the overall risk of bias was moderately high. Sixteen studies including 3240 participants reported outcomes on depressive diagnosis. The risk of having a depressive disorder post-intervention was reduced immediately compared with no intervention (15 studies; 3115 participants risk difference (RD) -0.09; 95% confidence interval (CI) -0.14 to -0.05; P<0.0003), at three to nine months (14 studies; 1842 participants; RD -0.11; 95% CI -0.16 to -0.06) and at 12 months (10 studies; 1750 participants; RD -0.06; 95% CI -0.11 to -0.01). There was no evidence for continued efficacy at 24 months (eight studies; 2084 participant; RD -0.01; 95% CI -0.04 to 0.03) but limited evidence of efficacy at 36 months (two studies; 464 participants; RD -0.10; 95% CI -0.19 to -0.02). There was significant heterogeneity in all these findings. There was no evidence of efficacy in the few studies that compared intervention with placebo or attention controls.\rAuthors' conclusions There is some evidence fromthis review that targeted and universal depression prevention programmesmay prevent the onset of depressive disorders compared with no intervention. However, allocation concealment is unclear in most studies, and there is heterogeneity in the findings. The persistence of findings suggests that this is real and not a placebo effect.

Cochrane Database of Systematic Reviews, CD003380(12) :

Legrand, F. D., Thatcher, J.

Acute mood responses to a 15-minute long walking session at self-selected intensity: Effects of an experimentally-induced telic or paratelic state

In the present controlled experiment, we examine the influence of opposite states of mind (the \"telic\" vs. \"paratelic\" state) on mood response to a 15min long walk at self-selected pace. Fifty-five first-year students were randomized to a telic (n = 22) or paratelic (n = 33) motivational environment. These opposed motivational environments were created using established reversal theory based procedures to induce the telic versus paratelic state. More than 90% of participants walked within a motivational state corresponding to the environment they were allocated. No significant mood changes (neither positive, nor negative) occurred pre- to postexercise in participants who walked with the telic state operative (p > .05). This has important implications when considering the use of exercise to relieve depression in clinical populations. Also, our findings shed new light on the reasons why not all individuals respond in the same way to moderate exercise. Practically, these results suggest that motivational state should be considered to optimize the mood enhancing effects of aerobic exercise. (copyright) 2011 American Psychological Association.

Emotion, 11(5) : 1040- 1045

Lemmens, S. G., Born, J. M., Martens, E. A., Martens, M. J., Westerterp-Plantenga, M. S.

Influence of consumption of a high-protein vs. high-carbohydrate meal on the physiological cortisol and psychological mood response in men and women

Consumption of meals with different macronutrient contents, especially high in carbohydrates, may influence the stress-induced physiological and psychological response. The objective of this study was to investigate effects of consumption of a high-protein vs. high-carbohydrate meal on the physiological cortisol response and psychological mood response. Subjects (n = 38, 19 m/19f, age =25 (plus or minus) 9 yrs, BMI = 25.0 (plus or minus) 3.3 kg/m2) came to the university four times, fasted, for either condition: rest-protein, stress-protein, rest-carbohydrate, stress-carbohydrate (randomized cross-over design). Stress was induced by means of a psychological computer-test. The test-meal was either a high-protein meal (En% P/C/F 65/5/30) or a high-carbohydrate meal (En% P/C/F 6/64/30), both meals were matched for energy density (4 kJ/g) and daily energy requirements (30%). Per test-session salivary cortisol levels, appetite profile, mood state and level of anxiety were measured. High hunger, low satiety (81 (plus or minus) 16, 12 (plus or minus) 15 mm VAS) confirmed the fasted state. The stress condition was confirmed by increased feelings of depression, tension, anger, anxiety (AUC stress vs. rest p < 0.02). Consumption of the high-protein vs. high-carbohydrate meal did not affect feelings of depression, tension, anger, anxiety. Cortisol levels did not differ between the four test-sessions in men and women (AUC nmol(middle dot)min/L p > 0.1). Consumption of the test-meals increased cortisol levels in men in all conditions (p < 0.01), and in women in the rest-protein and stress-protein condition (p < 0.03). Men showed higher cortisol levels than women (AUC nmol(middle dot)min/L p < 0.0001). Consumption of meals with different macronutrient contents, i.e. high-protein vs. high- carbohydrate, does not influence the physiological and psychological response differentially. Men show a higher meal-induced salivary cortisol response compared with women.

PLoS ONE, 6(2) : e16826

Kim, G. H., Kim, K., Park, H.

Outcomes of a program to reduce depression

Depression is increasing among Korean college students. Moreover, it is common for depressed individuals to consider attempting suicide. The purpose of this study therefore was to develop and examine the effectiveness of an int ived a depression-reducing program in eight 1-hr weekly sessions. Measures of suicidal ideation and depression were administered. The program has effects on suicidal ideation and depression among female college students. The findings suggest that the study program may be useful in reducing suicidal ideation and depression among female college students. (copyright) The Author(s) 2011.

Western Journal of Nursing Research, 33(4) : 560- 576

Hetrick, S. E., Cox, G. R., Merry, S. N.

Treatment-resistant depression in adolescents: Is the addition of cognitive behavioral therapy of benefit

Psychol Res Behav Manag, 4 : 97- 112

Kauer, S., Reid, S., Crooke, A., Khor, A., Patton, G., Jorm, A., Jackson, H.

Emotional self-awareness: Preliminary analyses of a RCT using a cellular phone self-monitoring program (mobiletype) to decrease early symptoms of depression (Conference abstract)

Purpose: Depression is a severe, recurrent condition that affects many people worldwide. Sixty percent of people who have one depressive episode will have another. In addition, up to 30%of young people experience depressive symptoms by 18 years of age. While these symptoms may be mild initially, many progress to moderate and then severe symptoms of depression. To date, no effective strategies exist that curtail the progression of mild depression to major depressive disorder. Effective early intervention programs need to be low cost and easy to use whilst also retaining the interest of young people. Self-monitoring has potential as an early intervention tool for young people, particularly when cell phones are used as a medium. Self-monitoringis a simple technique often used in behavioral therapy to increase awareness about mood and stressful events. In turn, emotional self-awareness is likely to decrease symptoms of depression. Previous qualitative research indicates that self-monitoring via cell phones increases emotional self-awareness in five ways: awareness of feelings, the ability to identify these feelings, communication of emotions to others, understanding the context of emotions (causes and consequences) and decision-making regarding emotions. This RCT investigates (i) whether self-monitoring increases young people's awareness of their moods and reduces depressive symptoms and (ii) whether emotional self-awareness mediates the relationship between self-monitoring and depressive symptoms. Methods: To date, 110 young people (between14 and 24 years of age) have been identified by their GP as being at risk of depression and recruited in rural and metropolitan Victoria, Australia (recruitment to finish in September 2010). Participants have been randomly assigned to either the intervention group (61 participants), where they monitored their mood, stress and daily activities, or the comparison group (48 participants), where the questions about mood and stress were excluded. Participants completed baseline, immediate follow-up and 6-week follow-up measures of depression as well as measures of emotional self-awareness. Results: Results will be presented on the associations between self-monitoring, adolescents' emotional self-awareness and depressive symptoms. Preliminary analyses show that selfmonitoring increases emotional self-awareness and decreases depressive symptoms. Regression analyses will be presented examining the mediation effects of emotional self-awareness on the relationship between self-monitoring and depressive symptoms. Conclusions: Self-monitoring, combined with technology, is a simple early intervention technique that has the potential to reduce depressive symptoms. Increasing young people's awareness and understanding of their emotions may decrease the number of young people progressing from mild depressive symptoms to major depressive disorder.

Journal of Adolescent Health, 48(2) : S91- S92

Hoek, Willemijn, Marko, Monika, Fogel, Joshua, Schuurmans, Josien, Gladstone, Tracy, Bradford, Nathan, Domanico, Rocco, Fagan, Blake, Bell, Carl, Reinecke, Mark A., VanVoorhees, Benjamin W.

Randomized controlled trial of primary care physician motivational interviewing versus brief advice to engage adolescents with an Internet-based depression prevention intervention: 6-month outcomes and predictors of improvement

We believe that primary care physicians could play a key role in engaging youth with a depression prevention intervention. We developed CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral and Interpersonal Training), which is an adolescent Internet-based behavior change model. We conducted a randomized comparison of two approaches in engaging adolescents with the Internet intervention: primary care physician (PCP) motivational interview + CATCH-IT Internet program (MI) vs PCP brief advice + CATCH-IT Internet program (BA). The participants (N = 84) were recruited by screening for risk of depression in 13 primary care practices. We compared depressive disorder outcomes between groups and within groups over 6 months and examined the potential predictors and moderators of outcomes across both study arms. Depressive symptom scores declined from baseline to 6 weeks with these statistically significant reductions sustained at the 6 months follow-up in both groups. No significant interactions with treatment condition were found. However, by 6 months, the MI group demonstrated significantly fewer depressive episodes and reported less hopelessness as compared with the BA group. Hierarchical linear modeling regressions showed higher ratings of ease of use of the Internet program predicting lower depressive symptom levels over 6 months. In conclusion, a primary care/Internet-based intervention model among adolescents demonstrated reductions in depressed mood over 6 months and may result in fewer depressive episodes.\rPublished by Mosby, Inc.

Translational Research, 158(6) : 315- 325

Hides, L. M., Elkins, K. S., Scaffidi, A., Cotton, S. M., Carroll, S., Lubman, D. I.

Does the addition of integrated cognitive behaviour therapy and motivational interviewing improve the outcomes of standard care for young people with comorbid depression and substance misuse?

Objective: To determine whether the addition of cognitive behaviour therapy and motivational interviewing (CBT/MI) to standard alcohol and other drug (AOD) care improves outcomes for young people with comorbid depression and substance misuse. Participants and setting: Participants were young people with comorbid depression (Kessler Psychological Distress Scale score (greater-than or equal to)17) and substance misuse (mainly alcohol and/or cannabis) seeking treatment at two youth AOD services in Melbourne, Australia. The study was conducted between September 2006 and September 2008. Sixty young people received CBT/MI in addition to standard care (SC) (the SC+CBT/MI group) and 28 received SC only (the SC group). Main outcome measures: Depressive symptoms and AOD use in the previous 30 days, measured at baseline and at 3-month and 6-month follow-up. Results: Compared with participants in the SC group, those in the SC+CBT/MI group showed significant reductions in depression and cannabis use and increased social contact and motivation to change substance use at 3-month follow- up. However, at 6- month follow-up, the SC group had achieved similar improvements to the CBT/MI group on these variables. All young people achieved significant improvements in functioning and quality of life variables over time, regardless of treatment group. No changes in AOD use were found in either group at 6-month follow-up. Conclusion: The delivery of CBT/MI in addition to SC may achieve accelerated treatment gains in the short term.

Medical Journal of Australia, 195(3 SUPPL.) : S31-S37