Disorders - depressive disorders
Emslie, G. J., Findling, R. L., Yeung, P. P., Kunz, N. R., Li, Y.
OBJECTIVE: The safety, efficacy, and tolerability of venlafaxine extended release (ER) in subjects ages 7 to 17 years with major
depressive disorder were evaluated in two multicenter, randomized, double-blind, placebo-controlled trials conducted between October 1997 and August
2001. METHOD: Participants received venlafaxine ER (flexible dose, based on body weight; intent to treat, n = 169) or placebo (intent to treat, n =
165) for up to 8 weeks. The primary efficacy variable was the change from baseline in the Children's Depression Rating Scale-Revised score at week
8. RESULTS: There were no statistically significant differences between venlafaxine ER and placebo on the Children's Depression Rating Scale-Revised
in either study. A post hoc age subgroup analysis of the pooled data showed greater improvement on the Children's Depression Rating Scale-Revised
with venlafaxine ER than with placebo (-24.4 versus -19.9; p = .022) among adolescents (ages 12-17), but not among children (ages 7-11). The most
common adverse events were anorexia and abdominal pain. Hostility and suicide-related events were more common in venlafaxine ER-treated participants
than in placebo-treated participants. There were no completed suicides. CONCLUSIONS: Venlafaxine ER may be effective in depressed adolescents.
However, its safety and efficacy in pediatric patients has not been established. Prescribers should monitor for signs of suicidal ideation and
hostility in pediatric patients taking venlafaxine ER. Copyright 2007 copyright American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 46(4) : 479-
488
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Serotonin-norepinephrine reuptake inhibitors
(SNRIs)
Emslie,
Graham J., Yeung, Paul P., Kunz, Nadia R.
INTRODUCTION: Because major depressive disorder (MDD) is often chronic
and recurrent, even pediatric patients who are treated successfully during an acute episode may need longer-term treatment. Yet, data on long-term
treatment with antidepressants in pediatric MDD are limited. OBJECTIVE: To evaluate long-term effectiveness and safety of treatment with venlafaxine
extended-release (ER) in children and adolescents with MDD. METHODS: Subjects (n=86) 7-17 years of age with MDD entered a multicenter, open-label
study of flexible-dose venlafaxine ER for 6 weeks of acute treatment, followed by continuation treatment for up to 6 months total treatment. The
primary efficacy variable was the Children's Depression Rating Scale-Revised (CDRS-R) total score (intent-to-treat population). RESULTS: Mean CDRS-R
total score decreased from 60.1+/-10.0 at baseline to 36.3+/-13.1 at week 6, and to 33.8+/-15.0 at 6 months (last observation carried forward). Among
completers (n=36), the mean CDRS-R total score was 24.3+/-7.6 at the end of 6 months of treatment. The most frequent treatment-emergent adverse
events were headache (53%), nausea (26%), infection (24%), abdominal pain (22%), vomiting (21%), and pharyngitis (19%). Fifteen (17%) participants
discontinued due to adverse events, 9 of whom did so within the first 6 weeks. Serious adverse events (suicide attempt [two], hostility [two],
hallucinations, depression, and pharyngitis) occurred in seven patients. There were no suicides. CONCLUSION: Most improvement with venlafaxine ER
occurs during the first 6 weeks of treatment. Prescribers should be alert to signs of suicidal ideation and hostility in pediatric patients.
CNS Spectrums, 12(3) : 223-
33
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Serotonin-norepinephrine reuptake inhibitors
(SNRIs)
Goodyer, I., Dubicka, B., Wilkinson, P., Kelvin, R., Roberts, C., Byford, S., Breen, S., Ford, C., Barrett, B., Leech, A., Rothwell, J., White, L., Harrington, R.
Objective: To determine whether a combination of a selective serotonin reuptake inhibitor (SSRI) and cognitive behaviour therapy (CBT)
together with clinical care is more effective in the short term than an SSRI and clinical care alone in adolescents with moderate to severe major
depression. Design: Pragmatic randomised controlled superiority trial. Setting: 6 outpatient clinics in Manchester and Cambridge. Participants: 208
adolescents, aged 11-17, with moderate to severe major or probable major depression who had not responded to a brief initial intervention.
Adolescents with suicidality, depressive psychosis, or conduct disorder were included. Interventions: 103 adolescents received an SSRI and routine
care; 105 received an SSRI, routine care, and CBT. The trial lasted 12 weeks, followed by a 16 week maintenance phase. Main outcome measures: Change
in score on the Health of the Nation outcome scales for children and adolescents (primary outcome) from baseline with 12 weeks as the primary and 28
weeks as the follow-up end point. Secondary measures were change in scores on the mood and feelings questionnaire, the revised children's depression
rating scale, the children's global assessment scale, and the clinical global impression improvement scale. Results: At 12 weeks the treatment
effect for the primary outcome was -0.64 (95% confidence interval -2.54 to 1.26, P=0.50). In a longitudinal analysis, there was no difference in
effectiveness of treatment for the primary (average treatment effect 0.001, -1.52 to 1.52, P=0.99) or secondary outcome measures. On average there
was a decrease in suicidal thoughts and self harm. There was no evidence of a protective effect of cognitive behaviour therapy on suicidal thinking
or action. By 28 weeks, 57% were much or very much improved with 20% remaining unimproved. Conclusions: For adolescents with moderate to severe major
depression there is no evidence that the combination of CBT plus an SSRI in the presence of routine clinical care contributes to an improved outcome
by 28 weeks compared with the provision of routine clinical care plus an SSRI alone. Trial registration: Current Controlled Trials ISRCNT
83809224.
British Medical Journal., 335(7611) : 142-146
- 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)
Gillham, Jane E., Reivich, Karen J., Freres, Derek R., Chaplin,
Tara M., Shatte,
Andrew J., Samuels, Barbra, Elkon, Andrea G., Litzinger, Samantha, Lascher,
Marisa, Gallop, Robert, Seligman, Martin E.
The authors investigated the effectiveness and specificity of the Penn Resiliency Program (PRP; J. E.
Gillham, L. H. Jaycox, K. J. Reivich, M. E. P. Seligman, & T. Silver, 1990), a cognitive-behavioral depression prevention program. Children (N = 697)
from 3 middle schools were randomly assigned to PRP, Control (CON), or the Penn Enhancement Program (PEP; K. J. Reivich, 1996; A. J. Shatte, 1997),
an alternate intervention that controls for nonspecific intervention ingredients. Children's depressive symptoms were assessed through 3 years of
follow-up. There was no intervention effect on average levels of depressive symptoms in the full sample. Findings varied by school. In 2 schools, PRP
significantly reduced depressive symptoms across the follow-up relative to both CON and PEP. In the 3rd school, PRP did not prevent depressive
symptoms. The authors discuss the findings in relation to previous research on PRP and the dissemination of prevention programs. (PsycINFO Database
Record (c) 2007 APA, all rights reserved) (journal abstract).
Journal of Consulting & Clinical Psychology, 75(1) : 9-
19
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Horowitz, J. L., Garber, J., Ciesla, J. A., Young, J. F., Mufson, L.
This
study evaluated the efficacy of 2 programs for preventing depressive symptoms in adolescents. Participants were 380 high school students randomly
assigned to a cognitive-behavioral program (CB), an interpersonal psychotherapy-adolescent skills training program (IPT-AST), or a no-intervention
control. The interventions involved eight 90-min weekly sessions run in small groups during wellness classes. At postintervention, students in both
the CB and IPT-AST groups reported significantly lower levels of depressive symptoms than did those in the no-intervention group, controlling for
baseline depression scores; the 2 intervention groups did not differ significantly from each other. The effect sizes, using Cohen's d, for the CB
intervention and the IPT-AST intervention were 0.37 and 0.26, respectively. Differences between control and intervention groups were largest for
adolescents with high levels of depressive symptoms at baseline. For a high-risk subgroup, defined as having scored in the top 25th percentile on the
baseline depression measure, the effect sizes for the CB and the IPT-AST interventions were 0.89 and 0.84, respectively. For the whole sample,
sociotropy and achievement orientation moderated the effect of the interventions. Intervention effects were short term and were not maintained at 6-
month follow-up.
Journal of Consulting & Clinical Psychology, 75(5) : 693-706
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Interpersonal therapy (IPT), Skills training
Cardemil, E. V., Reivich, K. J., Beevers, C. G., Seligman, M. E. P., James, J.
Cardemil E. V., James, J.
We present 2-year
follow-up data on the efficacy of the Penn Resiliency Program (PRP), a school-based depression prevention program, with low-income, racial/ethnic
minority children. This program taught cognitive and social problem-solving skills to 168 Latino and African American middle school children who were
at-risk for developing depressive symptoms by virtue of their low-income status. We had previously reported beneficial effects of the PRP up to 6
months after the conclusion of the program for the Latino children, but no clear effect for the African American children. In this paper, we extend
the analyses to 24 months after the conclusion of the PRP. We continue to find some beneficial effects for the Latino children and no differentially
beneficial effect for the African American children. Implications of findings and future research directions are discussed.
Behaviour Research & Therapy, 45(2) : 313-
327
- Year: 2007
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Burton, E., Stice,
E., Bearman, S. K., Rohde, P.
Objective: Conduct a randomized trial to test whether a cognitive behavioral
intervention designed to decrease de- pressive symptoms produces subsequent decreases in bulimic and substance use symptoms.\rMethod: Female
participants (N 1/4 145) with elevated depressive symptoms were randomly assigned to a 4-session depres- sion intervention or a measurement-only
condition and assessed through 6-month follow-up.\rResults: Relative to control partici- pants, intervention participants showed decreases in
depressive symptoms. Inter-\rvention participants also showed signifi- cantly greater reductions in bulimic symptoms, but not substance use, and
change in depressive symptoms medi- ated this effect for bulimic symptoms.\rConclusion: The results provide experi- mental support for the theory
that affect disturbances contribute to bulimic path- ology, but do not support the affect regu- lation theory of substance use. VC 2006 by Wiley
Periodicals, Inc.\rKeywords: affect-regulation; depression; bulimia; substance use; randomized trial
International Journal of Eating Disorders, 40(1) : 27-
36
- Year: 2007
- Problem: Depressive Disorders, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Balkin, RS., Tietjen-Smith, T., Caldwell,
C., Shen, Y
Depression is a prevalent issue for women on college campuses. Undergraduate women participated in (a) an
aerobic exercise class, (b) a weight-lifting class, or (c) a control group to determine the effect of exercise on depressive symptoms. Participants
in the aerobic exercise group exhibited a significant decrease in depressive symptoms. Implications for college counselors are discussed.
Adultspan, 6 : 30-5
- Year: 2007
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Bolton, Paul, Bass, Judith, Betancourt,
Theresa, Speelman, Liesbeth, Onyango, Grace, Clougherty, Kathleen F., Neugebauer, Richard, Murray, Laura, Verdeli, Helen
CONTEXT: Prior qualitative work with internally displaced persons in war-affected northern Uganda showed significant
mental health and psychosocial problems. OBJECTIVE: To assess effect of locally feasible interventions on depression, anxiety, and conduct problem
symptoms among adolescent survivors of war and displacement in northern Uganda. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial from
May 2005 through December 2005 of 314 adolescents (aged 14-17 years) in 2 camps for internally displaced persons in northern Uganda. INTERVENTIONS:
Locally developed screening tools assessed the effectiveness of interventions in reducing symptoms of depression and anxiety, ameliorating conduct
problems, and improving function among those who met study criteria and were randomly allocated (105, psychotherapy-based intervention [group
interpersonal psychotherapy]; 105, activity-based intervention [creative play]; 104, wait-control group [individuals wait listed to receive treatment
at study end]). Intervention groups met weekly for 16 weeks. Participants and controls were reassessed at end of study. MAIN OUTCOME MEASURES:
JAMA, 298(5) : 519-27
- Year: 2007
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Interpersonal therapy (IPT)
Attari, A., Moghaddam, Y., Hasanzadeh, A., Soltani, M., Mahmoodi, M.
Background: The incidence of
depression is 0.9% in preschoolers, 1.9% in school age children, and 4.7% in adolescents. Current antidepressant treatment of mood disorders in
children and adolescents is still in the early phases of being validated with double-blind efficacy studies. In this study the efficacy of
nortriptyline has been compared with fluoxetine in the treatment of major depression in children and adolescents. Methods: This was a double-blind
clinical trial for 8 weeks, undertaken in the Isfahan Child and Adolescent Guidance outpatient Clinic, Isfahan, Iran. Subjects were 40 outpatients
children and adolescents (20 boys and 20 girls) aged 7-16 years of old who met the Diagnostic and Statistical Manual of Mental Disorders, Forth
Edition, for Major Depression. To determine the scores of two groups (Baseline and after treatment), we used Children Depression Inventory (CDI).
Subjects were randomly assigned to receive nortriptyline 2mg/kg/day for 8 weeks (group A) or fluoxetine 1mg/kg/day for 8 weeks, (group B). Paired t-
test was used to compare the mean of CDI score of each group before and after treatment. To compare the reduction in the Children Depression
Inventory score, an unpaired t-test was used. Results: The mean depression score was 28.9 (SD+/-8.46) before intervention in fluoxetine group while
that was 28.4 (SD+/-8.76) in nortriptyline group. Independent t-test showed a significant difference between after treatment mean depression scores
in both groups (t=2.97, df=38, P=0.004). The changes at the endpoint compared with baseline were - 10.95+/-2.61 and -2.6+/-0.8 for fluoxetine and
nortriptyline, respectively. t- Paired test showed a significant decrease in mean depression score in fluoxetine group (P[less-than or equal
to]0.0001) while that was not significant one in nortriptyline group (P=0.34). At the endpoint (8th week), 10 cases 50% didn't meet the criteria of
Major Depression based on DSM-IV in fluoxetine group. Although, it was only 2 cases (10%) for nortriptyline group. Conclusion: The present study
suggest that the treatment with fluoxetine in subsiding depression was significantly preferable compared with nortriptyline. The general conclusion
of this study provides evidence in favor of an efficacy advantage of fluoxetine over nortriptyline in the treatment of depression in children and
adolescents.
Journal of Research in Medical Sciences, 11(1) : 24-30
- 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), Tricyclic antidepressants
Castellanos, N., Conrod, P.
Background: Personality-targeted cognitive-behavioural
interventions have been proven to be effective in reducing alcohol-related behaviours in adolescents. Aims: As these interventions target personality
traits linked to risk for non-addictive psychopathology, the aim of this study is to examine the extent to which this approach can also prevent the
onset or reduce relevant psychological problems in youth. Method: Participants aged 13-16 years (n=423) were randomly assigned to either a
personality matched cognitive-behavioural intervention or a no-intervention control. The personality matched interventions targeted four personality
risk factors: negative thinking (NT), anxiety sensitivity (AS), impulsivity (IMP), and sensation seeking (SS). Results: Baseline and follow-up data
were obtained on depression scores, panic attacks, and reckless behaviour. Results showed a moderate effect of the NT intervention on depression
scores, and a similar effect of the AS intervention on panic attack and truancy (i.e., school avoidance). A small but significant intervention effect
was found for shoplifting for the entire sample, as well as a moderate intervention effect on this outcome for the IMP intervention group.
Conclusions: These intervention effects indicate that personality-targeted interventions designed to prevent alcohol misuse, can concurrently reduce
other relevant psychological problems in youth. copyright Shadowfax Publishing and Informa UK Ltd.
Journal of Mental Health & Aging, 15(6) : 645-658
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Berard, Ray, Fong, Regan, Carpenter, David
J., Thomason, Christine, Wilkinson, Christel
OBJECTIVE: The aim of this study was to examine the efficacy, safety, and tolerability of
paroxetine in adolescents with unipolar major depression. METHOD: Two hundred eighty-six (286) adolescents with unipolar major depression were
randomly assigned to receive either paroxetine or placebo for 12 weeks. RESULTS: The proportion of Montgomery-Asberg Depression Rating Scale (MADRS)
responders (at least 50% reduction from baseline) for paroxetine and placebo were similar and not statistically different at endpoint (p = 0.702). A
similar result was obtained for change from baseline on the Kiddie-Schedule for Affective Disorders and Schizophrenia for School- Age Children (K-
SADS-L) depression subscale. Among secondary endpoints, only a significantly higher Clinical Global Impression-Improvement (CGI-I) response rate was
reported in paroxetine-treated patients versus placebo (69.2% versus 57.3%; p = 0.045). In general, results differed by age, with patients older than
16 years demonstrating a greater response to active treatment. This age group also reported more adverse experiences (AEs) relative to placebo than
younger adolescents. Overall, paroxetine was generally well tolerated (11% discontinued owing to an AE versus 7% of placebo-treated patients). A post
hoc analysis of AEs related to suicidal behavior suggested a greater incidence of these events for paroxetine than for placebo (4.4% versus 2.1%);
however, this difference was not statistically significant (odds ratio, 2.15, 95% Confidence Interval 0.45, 10.33; p = 0.502). CONCLUSIONS: No
statistically significant differences were observed for paroxetine compared with placebo on the two prospectively defined primary efficacy variables.
Paroxetine at 20-40 mg/day administered over a period of up to 12 weeks was generally well tolerated.
Journal of Child & Adolescent Psychopharmacology, 16(1-2) : 59-
75
- 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)