Disorders - depressive disorders
Chaplin,
Tara M., Gillham, Jane E., Reivich, Karen, Elkon, Andrea G., Samuels, Barbra, Freres, Derek R., Winder, Breanna, Seligman, Martin E.
Given the
dramatic increase in depression that occurs during early adolescence in girls, interventions must address the needs of girls. The authors examined
whether a depression prevention program, the Penn Resiliency Program, was more effective for girls in all-girls groups than in co-ed groups. Within
co-ed groups, the authors also tested whether there were greater effects for boys than for girls. Participants were 208 11- to 14-year-olds. Girls
were randomly assigned to all-girls groups, co-ed groups, or control. Boys were assigned to co-ed groups or control. Students completed
questionnaires on depressive symptoms, hopelessness, and explanatory style before and after the intervention. Girls groups were better than co-ed
groups in reducing girls' hopelessness and for session attendance rates but were similar to co-ed groups in reducing depressive symptoms. Co-ed
groups decreased depressive symptoms, but this did not differ by gender. Findings support prevention programs and suggest additional benefits of
girls groups. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract).
Journal of Early Adolescence, 26(1) : 110-
126
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Cheung, A. H., Emslie, G.
J., Mayes, T. L.
The dramatic
increase over the past 10 years in the amount of available clinical research on the use of antidepressants to treat major depression in children and
adolescents has substantially improved our knowledge of the safety and efficacy of these medications in the pediatric population. Many questions
remain, however, that highlight the need to continue research in this patient population rather than relying on the extrapolation of data from trials
involving adults. In this article, we review the current state of research into antidepressant therapy for major depression in children and
adolescents. In addition, we discuss methodologic issues and clinical implications specific to the pediatric population.
Canadian Medical
Association Journal., 174(2) : 193-200
- Year: 2006
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Antidepressants
(any)
Curry, J., Rohde, P., Simons, A., Silva, S., Vitiello, B., Kratochvil, C., Reinecke, M., et-al
OBJECTIVE: To identify predictors and moderators of response to acute treatments among depressed adolescents (N = 439) randomly assigned
to fluoxetine, cognitive-behavioral therapy (CBT), both fluoxetine and CBT, or clinical management with pill placebo in the Treatment for Adolescents
With Depression Study (TADS). METHOD: Potential baseline predictors and moderators were identified by a literature review. The outcome measure was a
week 12 predicted score derived from the Children's Depression Rating Scale-Revised (CDRS-R). For each candidate moderator or predictor, a general
linear model was conducted to examine main and interactive effects of treatment and the candidate variable on the CDRS-R predicted scores. RESULTS:
Adolescents who were younger, less chronically depressed, higher functioning, and less hopeless with less suicidal ideation, fewer melancholic
features or comorbid diagnoses, and greater expectations for improvement were more likely to benefit acutely than their counterparts. Combined
treatment, under no condition less effective than monotherapy, was more effective than fluoxetine for mild to moderate depression and for depression
with high levels of cognitive distortion, but not for severe depression or depression with low levels of cognitive distortion. Adolescents from
high-income families were as likely to benefit from CBT alone as from combined treatment. CONCLUSIONS: Younger and less severely impaired adolescents
are likely to respond better to acute treatment than older, more impaired, or multiply comorbid adolescents. Family income level, cognitive
distortions, and severity of depression may help clinicians to choose among acute interventions, but combined treatment proved robust in the presence
of moderators. Copyright 2006 copyright American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 45(12) : 1427-
1439
- 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), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Heiligenstein, John H., Hoog, Sharon L., Wagner, Karen Dineen, Findling, Robert L., Galil, Nora, Kaplan, Stuart, Busner, Joan, Nilsson, Mary E., Brown, Eileen B., Jacobson, Jennie G.
OBJECTIVE: The aim of this
study was to compare fluoxetine dosage titration to 40-60 mg/day with fixed fluoxetine 20-mg/day treatment for an additional 10 weeks in pediatric
outpatients with major depressive disorder (MDD) who had not met protocol-defined response criteria after 9-week acute fluoxetine treatment. METHODS:
Patients unresponsive (less than or equal to 30% decrease in Children's Depression Rating Scale-Revised [CDRS-R] score) after 9-week fluoxetine
treatment were randomly reassigned to continue at 20 mg/day or to increase to 40 mg/day. After 4 weeks, patients unresponsive to 40 mg/day could
receive 60 mg/day. RESULTS: Twenty-nine (29) patients, 9-17 years of age, received fluoxetine 40-60 mg/day (n = 14) or 20 mg/day (n = 15). At the
conclusion of this study phase, 10 patients (71%) on 40-60 mg/day met the response criteria, versus 5 patients (36%) on 20 mg/day (p = 0.128). Mean
CDRS-R scores improved in both treatment groups (fluoxetine 40-60 mg/day, -9.4; fluoxetine 20 mg/day, -1.5; p = 0.099). Adverse events were similar
in both groups. However, this study phase was statistically underpowered for detecting differences between treatment groups. CONCLUSION: More than
two thirds of patients whose dosage was increased responded within 10 weeks, suggesting dose escalation may benefit some patients. Approximately one
third of patients unresponsive to initial treatment with fluoxetine 20 mg responded to this fixed dosage within another 10 weeks. Fluoxetine 20-60
mg/day was well tolerated.
Journal of Child & Adolescent Psychopharmacology, 16(1-2) : 207-
17
- 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)
Hamamci, Z.
The aim of the study is to compare the effects of
psychodrama integrated with cognitive behavioral therapy and cognitive behavioral group therapy in the treatment of depression. Thirty-one university
students with moderate depression participated in this study. After the participants were randomly assigned to and control groups, group therapies
were conducted for 11 sessions over a period lasting nearly 3 months. The control group received no treatment. The Beck Depression Inventory (BDI),
the Automatic Thoughts Questionnaire (ATQ) and the Dysfunctional Attitude Scale (DAS) were administered to the participants at three different
occasions: pre-treatment, post-treatment, and 6-month follow-up. A 3 x 3 ANOVA was used to examine the effectiveness of the treatments. The results
indicated that both psychodrama integrated with cognitive behavioral therapy, and cognitive behavioral group therapy alone, led to reduction in the
level of depression, negative automatic thoughts, and dysfunctional attitudes of participants. However, there were no significant differences between
the two treatments in terms of their effectiveness. copyright 2006 Elsevier Inc. All rights reserved.
Arts in Psychotherapy., 33(3) : 199-
207
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Creative expression: music, dance, drama, art
Gillham, J.
E., Reivich, K. J., Freres, D. R., Lascher, M., Litzinger, S., Shatte, A., Seligman, M. E.
Previous studies suggest that school-based
cognitive-behavioral interventions can reduce and prevent depressive symptoms in youth. This pilot study investigated the effectiveness of a
cognitive-behavioral depression prevention program, the Penn Resiliency Program for Children and Adolescents (the PRP-CA), when combined with a
parent intervention component. Forty-four middle school students and their parents were randomly assigned to the enhanced PRP (the PRP-CA plus parent
program) or control conditions. Students completed measures of depression and anxiety symptoms at baseline and 2 weeks, 6 months, and 1 year after
the intervention ended. The combined version of the PRP significantly reduced symptoms of depression and anxiety during the follow-up period.
Children assigned to the intervention condition were less likely than controls to report clinical levels of anxiety symptoms. Findings suggest that
school-based cognitive-behavioral interventions that include parents may prevent depression and anxiety symptoms in early adolescence. (PsycINFO
Database Record (c) 2012 APA, all rights reserved)
School Psychology Quarterly, 21(3) : 323-48
- Year: 2006
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Gillham, J. E., Hamilton, J., Freres, D. R., Patton, K., Gallop, R.
This study evaluated the Penn Resiliency Program's
effectiveness in preventing depression when delivered by therapists in a primary care setting. Two-hundred and seventy-one 11- and 12-year-olds, with
elevated depressive symptoms, were randomized to PRP or usual care. Over the 2-year follow-up, PRP improved explanatory style for positive events.
PRP's effects on depressive symptoms and explanatory style for negative events were moderated by sex, with girls benefiting more than boys. Stronger
effects were seen in high-fidelity groups than low-fidelity groups. PRP did not significantly prevent depressive disorders but significantly
prevented depression, anxiety, and adjustment disorders (when combined) among high-symptom participants. Findings are discussed in relation to
previous PRP studies and research on the dissemination of psychological interventions. copyright 2006 Springer Science+Business Media, Inc.
Journal of Abnormal Child Psychology., 34(2) : 203-
219
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Emslie, Graham, Wagner, Karen Dineen, Kutcher, Stan, Krulewicz, Stan, Fong, Regan, Carpenter, David J., Lipschitz, Alan, Machin, Andrea, Wilkinson, Christel
Objective: To assess the efficacy and tolerability of paroxetine in pediatric major depressive
disorder. Method: Subjects 7 to 17 years old with major depressive disorder received paroxetine (10-50 mg/day) or placebo for 8 weeks from 2000 to
2001. The primary efficacy measure was change from baseline in the Children's Depression Rating Scale-Revised total score at week 8 last observation
carried forward). Safety was primarily assessed by spontaneous reporting of adverse events. Results: A total of 206 patients (intent to treat) were
randomized to paroxetine (n = 104) or placebo (n=102). Week 8 Children's Depression Rating Scale-Revised total score adjusted mean changes from
baseline for patients receiving paroxetine and placebo were -22.58 (SE 1.47) and -23.38 points (SE 1.60), respectively (0.80, 95% confidence interval
-3.09 to 4.69, p=0.684). Increased cough (5.9% versus 2.9%), dyspepsia (5.9% versus 2.9%), vomiting (5.9% versus 2. 0%), and dizziness (5.0% versus
1.0%) occurred in >=5% of the paroxetine group and at least twice that of the placebo group. Six of 104 (5.8%) paroxetine patients reported serious
adverse events compared to 1 placebo patient (1.0%). The incidence of adverse events of suicidal behavior and/or ideation while taking study
medication (excluding taper) was 1.92% (2/104) for paroxetine versus 0.98% (1/102) for placebo. Conclusions: Paroxetine was not shown to be more
efficacious than placebo for treating pediatric major depressive disorder. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal
abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 45(6) : 709-
719
- 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)
Cuijpers, Pim, vanStraten, Annemieke, Smits, Niels, Smit, Filip
Depression in children and adolescents is considerably undertreated, and the school may be a good setting for identifying and treating
depression. We conducted a meta-analysis of studies in which students were screened for depression, and those with depressive symptoms were treated
with a psychological intervention. Only randomised controlled trials were included. Eight studies met the inclusion criteria. Five studies focused on
younger children (7-14 years) and three studies were aimed at adolescents (12-19 years). In total 5803 students were screened, of whom 7.2% were
included in the intervention studies (95% CI: 7.1-7.3). The 'numbers-needed-to-screen' was 31 (95% CI: 27-32), which means that 31 students had to
be screened in order to generate one successfully treated case of depression. The effects of the psychological treatments at post-test were compared
to control conditions in the 8 studies comprising 12 contrast groups, with a total of 413 students. The mean effect size was 0.55 (95% CI: 0.35-
0.76). There were not enough studies to examine whether specific psychotherapies were superior to other psychotherapies. Although the number of
studies is small and their quality is limited, screening and early intervention at schools may be an effective strategy to reduce the burden of
disease from depression in children and adolescents. More research on the (negative) effects of these interventions is needed. [References: 37]
European
Child & Adolescent Psychiatry, 15(5) : 300-7
- Year: 2006
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other service delivery and improvement
interventions
Donnelly, Craig L., Wagner, Karen Dineen, Rynn, Moira, Ambrosini, Paul, Landau, Phyllis, Yang, Ruoyong, Wohlberg, Christopher J.
OBJECTIVE: To explore time to first response and time to first persistent response of sertraline versus placebo and compare these
parameters between children (6-11 years old, n = 177) and adolescents (12-17 years old, n = 199) with major depressive disorder. METHOD: A 10-week
placebo-controlled treatment was followed by a 24-week open-label sertraline treatment. The double-blind studies were not powered to detect efficacy
differences between age groups. A post hoc analysis explored time to first response and first persistent response using the Children's Depression
Rating Scale-Revised and Clinical Global Impressions-Improvement predefined criteria. RESULTS: There were no statistically significant differences in
time to first response or first persistent response between sertraline and placebo in children, except for time to first response on Clinical Global
Impressions-Improvement. Sertraline had a significantly faster time to first persistent response in adolescents compared to placebo. Within treatment
groups, children had a significantly faster time to first response than adolescents, whether treated with placebo or sertraline, but not on time to
first persistent response. Both age groups showed similar improvement over 34 weeks of treatment. CONCLUSION: In the double-blind studies, children
and adolescents had different patterns of response with sertraline vs. placebo.
Journal of the American Academy of Child & Adolescent Psychiatry, 45(10) : 1162-
70
- 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)
Cutuli, J. J., Chaplin, T. M., Gillham, J. E., Reivich, K. J., Seligman, M. E. P.
Children who exhibit elevated levels of conduct problems are at increased risk for developing co-occurring depression symptoms, especially
during adolescence. This study tests the effectiveness of a manualized after school intervention (the Penn Resiliency Program [PRP]) for the
prevention of depression symptoms among a subset of middle-school-aged students who exhibited elevated levels of conduct problems, but not depression
symptoms, at the start of the study. Longitudinal analyses demonstrate that the program successfully prevented elevations in depression symptoms
across early- to mid-adolescence compared to nointervention controls. copyright 2006 New York Academy of Sciences.
Annals of the New York Academy of Sciences, 1094 : 282-286
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Larun, L., Nordheim, L. V., Ekeland, E., Hagen, K. B., Heian, F.
BACKGROUND: Depression and anxiety are common psychological
disorders for children and adolescents. Psychological (e.g. psychotherapy), psychosocial (e.g. cognitive behavioral therapy) and biological (e.g.
SSRIs or tricyclic drugs) treatments are the most common treatments being offered. The large variety of therapeutic interventions give rise to
questions of clinical effectiveness and side effects. Physical exercise is inexpensive with few, if any, side effects. OBJECTIVES: To assess the
effects of exercise interventions in reducing or preventing anxiety or depression in children and young people up to 20 years of age. SEARCH
STRATEGY: We searched the Cochrane Controlled Trials Register (latest issue available), MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and Sportdiscus up to
August 2005. SELECTION CRITERIA: Randomised trials of vigorous exercise interventions for children and young people up to the age of 20, with outcome
measures for depression and anxiety. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion, assessed methodological
quality and extracted data. The trials were combined using meta-analysis methods. A narrative synthesis was performed when the reported data did not
allow statistical pooling. MAIN RESULTS: Sixteen studies with a total of 1191 participants between 11 and 19 years of age were included.Eleven trials
compared vigourous exercise versus no intervention in a general population of children. Six studies reporting anxiety scores showed a non-significant
trend in favour of the exercise group (standard mean difference (SMD) (random effects model) -0.48, 95% confidence interval (CI) -0.97 to 0.01). Five
studies reporting depression scores showed a statistically significant difference in favour of the exercise group (SMD (random effects model) -0.66,
95% CI -1.25 to -0.08). However, all trials were generally of low methodological quality and they were highly heterogeneous with regard to the
population, intervention and measurement instruments used. One small trial investigated children in treatment showed no statistically significant
difference in depression scores in favour of the control group (SMD (fixed effects model) 0.78, 95% CI -0.47 to 2.04). No studies reported anxiety
scores for children in treatment.Five trials comparing vigorous exercise to low intensity exercise show no statistically significant difference in
depression and anxiety scores in the general population of children. Three trials reported anxiety scores (SMD (fixed effects model) -0.14, 95% CI -
0.41 to 0.13). Two trials reported depression scores (SMD (fixed effects model) -0.15, 95% CI -0.44 to 0.14). Two small trials found no difference in
depression scores for children in treatment (SMD (fixed effects model) -0.31, 95% CI -0.78 to 0.16). No studies reported anxiety scores for children
in treatment.Four trials comparing exercise with psychosocial interventions showed no statistically significant difference in depression and anxiety
scores in the general population of children. Two trials reported anxiety scores (SMD (fixed effects model) -0.13, 95% CI -0.43 to 0.17). Two trials
reported depression scores (SMD (fixed effects model) 0.10, 95% CI-0.21 to 0.41). One trial found no difference in depression scores for children in
treatment (SMD (fixed effects model) -0.31, 95% CI -0.97 to 0.35). No studies reported anxiety scores for children in treatment. AUTHORS'
CONCLUSIONS: Whilst there appears to be a small effect in favour of exercise in reducing depression and anxiety scores in the general population of
children and adolescents, the small number of studies included and the clinical diversity of participants, interventions and methods of measurement
limit the ability to draw conclusions. It makes little difference whether the exercise is of high or low intensity. The effect of exercise for
children in treatment for anxiety and depression is unknown as the evidence base is scarce. [References: 50]
Cochrane Database of Systematic
Reviews, 3 : CD004691
- Year: 2006
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise