Disorders - Depressive Disorders
Beardslee, William R., Gladstone, Tracy R. G., Wright, Ellen J., Cooper, Andrew B.
OBJECTIVE: Depression in parents is a prevalent and impairing illness that is
encountered frequently in medical practice. Children of depressed parents are at risk for psychopathology and other difficulties. A series of recent
national reports have recommended the development of prevention efforts targeting children of depressed parents. Yet, to date, few controlled
prevention studies of depression in children and adolescents have been conducted. In this study, we report the evaluation of 2 preventive
intervention strategies that target children living in homes with depressed parents. Both are public health approaches that were designed to be used
by a wide range of practitioners from a variety of disciplines, including pediatricians, internists, school counselors, nurses, and mental health
practitioners. We adopted a developmental perspective and intervened with families when children were entering the age of highest risk for depression
onset (ie, adolescence). We chose a family-based approach to prevention and sought to reduce risk factors and enhance protective factors for early
adolescents by increasing positive interactions between parents and children, and by increasing understanding of the illness for everyone in the
family. Our prevention approaches were designed to provide information about mood disorders to parents, to equip parents with the skills they need to
communicate information to their children, and to open a dialogue with their children about the effects of parental depression. We hypothesized that
participation in these prevention programs would result in parental change in child-related behaviors and attitudes about depression and its impact
on the family. In addition, we hypothesized that this parental change would produce change in children's self-understanding, and in children's
depressive symptomatology. METHODS: We conducted a large-scale efficacy trial of 2 manual-based preventive intervention programs that were designed
to be used widely in public health settings. These interventions target the relatively healthy children (ages 8-15) of parents with mood disorder.
Ninety-three families (88.5% of our initial sample), including 121 children, participated in this study through the fourth assessment point. These
families were assigned randomly to either a lecture or a clinician-facilitated intervention. Both interventions were specified in manuals. The
lecture condition consisted of 2 separate meetings delivered in a group format without children present. The clinician-facilitated condition
consisted of 6 to 11 sessions, including separate meetings with parents and children, and a family meeting in which the parents led a discussion of
the illness and of positive steps that can be taken to promote healthy functioning in the children. In addition, telephone contacts or refresher
meetings were conducted at 6- to 9-month intervals. In both conditions, psychoeducational material about mood disorders, risk, and resilience was
presented and efforts were made to decrease feelings of guilt and blame in children. Parents were helped to build resilience in their children
through encouraging their friendships, their success outside of the home, and their understanding of parental illness and of themselves. In addition,
in the clinician-facilitated condition, efforts were made to link the psychoeducational material presented to the family's own unique illness
experience. To address directly how their lives had changed, all family members in both conditions were assessed for psychopathology and for overall
functioning at intake, and for psychopathology, functioning, and response to intervention immediately postintervention, approximately 1 year
postintervention, and again approximately 2.5 years postintervention. RESULTS: We examined the outcomes of child understanding and internalizing
symptomatology, and a number of predictor variables, using repeated measures analyses with generalized estimating equations. We found that parents in
both conditions reported significant change in child-related behaviors
Pediatrics, 112(2) : e119-
31
- Year: 2003
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Braconnier, Alain,
OBJECTIVE: To date, two randomized, double-blind trials of serotonin reuptake inhibitors (SRIs) have shown that antidepressant
drugs are effective in treating adolescent depression. In contrast, tricyclic antidepressants (TCAs) are not superior to placebo. This has led to a
serotonin hypothesis in this age group. This study explores this hypothesis and compares paroxetine, a specific SRI, with clomipramine, a TCA with
SRI activity. METHOD: One hundred twenty-one adolescents (aged 12-20 years) with major depression were enrolled and randomized (stratified for age)
to 20 or 40 mg of paroxetine or 75 mg or 150 mg of clomipramine for 8 weeks. Primary outcome measurements were the Clinical Global Impression (CGI)
scale and the Montgomery and Asberg Depression Rating Scale (MADRS). RESULTS: Of the 121 patients, 58 received clomipramine and 63 paroxetine. Based
on intent-to-treat analysis, both agents had similar efficacy, with no effect of age; 48.3% and 58.2% of the subjects receiving clomipramine and
65.1% and 59.3% of those receiving paroxetine were rated responders on the MADRS and CGI scales, respectively. Study withdrawals were frequent in
both groups (41% and 31%, respectively), but side effects were significantly more frequent with clomipramine (69% versus 49.2%, respectively; p =
.027). CONCLUSION: Paroxetine and clomipramine exhibit similar efficacy in adolescent depression. These data support the serotonin hypothesis but do
not confirm it in the absence of a placebo arm. Given the adverse event profile of clomipramine, specific SRIs should be preferred. However, more
placebo-controlled studies are needed to establish definitively the efficacy of SRIs in this age group.
Journal of the American Academy of Child & Adolescent Psychiatry, 42(1) : 22-
9
- Year: 2003
- 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
Brooks, Sarah J., Krulewicz, Stanley P., Kutcher, Stan
OBJECTIVE: Self-report
instruments commonly used to assess depression in adolescents have limited or unknown psychometric properties in this age group. We report the
evaluative properties of the Kutcher Adolescent Depression Scale (KADS), a self-report scale designed specifically for identifying depressed
adolescents and for monitoring symptom severity over time. METHODS: One hundred and six adolescents with major depression disorder (MDD) enrolled in
an 8-week, double-blind, placebo-controlled study of paroxetine. Efficacy assessments were conducted on days 0 (baseline), 7, 14, 21, 28, 42, and 56
using the self-rated KADS and the clinician-rated Children's Depression Rating Scale-Revised (CDRS-R), Clinical Global Impression (CGI) of severity,
and Global Assessment of Functioning (GAF) scale. The data were initially examined to establish which of the 16 KADS items showed greatest
sensitivity to change. Subsequent analyses then compared the evaluative properties of three versions of the KADS: the full-length KADS, a six-item
subscale previously established as a screening tool, and an 11-item subscale optimized for sensitivity to change. RESULTS: Within-subject
correlations among subjects' KADS scores and their clinician-rated scale scores showed that clinician-rated changes in severity were significantly
better corroborated by the 11-item KADS (mean correlations with the CDRS-R, CGI, and GAF: r = 0.69, 0.60, and -0.70, respectively) than by the six-
item KADS (r = 0.62, 0.56, and -0.63, respectively) and at least as well corroborated as by the full-length KADS (r = 0.64, 0.56, and -0.67,
respectively). Furthermore, in terms of mean percentage change in scores from day 0 to day 56, the 11-item KADS (59%) significantly outperformed the
full-length KADS (46%) and all three clinician-rated scales (43%, 37%, and 29%, respectively) and at least matched the performance of the six-item
KADS (56%). CONCLUSIONS: These results suggest that the 11-item self-rated KADS is a sensitive measure of treatment outcome in adolescents diagnosed
with MDD.
Journal of Child & Adolescent Psychopharmacology, 13(3) : 337-
49
- Year: 2003
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Cardemil, E.
V., Reivich, K. J., Seligman, M.
We present data on the efficacy of the Penn Resiliency Program (PRP) with low income minority children. This
school-based depression prevention program teaches cognitive and social problem-solving skills to groups of middle-school students who might be at-
risk for developing depressive symptoms by virtue of their low-income status. Our previous research had established the effectiveness of the original
PRP with predominately middle-income Caucasian children. We administered the PRP to 2 cohorts of low-income minority children: African American and
Latino 5th and 6th\rgraders. We found a clearly beneficial effect for the Latino children up to 6 months after the conclusion of the depression
prevention program, but no clear effect for the African American children.
Prevention &
Treatment, 5(Article 8) :
- Year: 2002
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Clarke, Gregory N., Hornbrook, Mark, Lynch, Frances, Polen, Michael, Gale, John, O'Connor, Elizabeth, Seeley, John R., Debar, Lynn
OBJECTIVE: A randomized, controlled effectiveness trial of group cognitive-behavioral therapy (CBT) for depressed
adolescent offspring of depressed parents in a health maintenance organization (HMO) was conducted. METHOD: Potential adult cases were found by
reviewing antidepressant medication prescriptions, mental health appointments, and medical charts. Introductory study letters signed by each
parent's treating physician were mailed to the appropriate adults. Eligible offspring aged 13 to 18 who met current DSM-III-R criteria for major
depression and/or dysthymia were randomly assigned to either usual HMO care (n = 47) or usual care plus a 16-session group CBT program (n = 41).
Assessments were conducted at baseline, after treatment, and at 12- and 24-month follow-up. RESULTS: Using intent-to-treat analyses, the authors were
unable to detect any significant advantage of the CBT program over usual care, either for depression diagnoses, continuous depression measures,
nonaffective measures, or functioning outcomes. CONCLUSIONS: Group CBT does not appear to be incrementally beneficial for depressed offspring of
depressed parents who are receiving other mental health care. However, given that many other studies have found positive effects of CBT for youth
depression, this single study should not be viewed as evidence that CBT is ineffective overall.
Journal of the American Academy of Child & Adolescent
Psychiatry, 41(3) : 305-13
- Year: 2002
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Baldwin, David S.
Escitalopram is a new antidepressant drug, available for clinical use in many countries. This review describes the properties
of escitalopram, summarizes the results of randomized controlled trials, and suggests that escitalopram has advantages over citalopram in the
treatment of depression. [References: 15]
Hospital Medicine, 63(11) : 668-
71
- Year: 2002
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Pfeffer, C. R., Jiang, H., Kakuma, T., Hwang, J., Metsch, M.
Objective\rThis study evaluated efficacy of a manual-based bereavement group intervention for children who suffered
suicide of a parent or sibling.\r\rMethod\rSeventy-five families (102 children) were screened from medical examiners' lists of suicide victims.
Fifty-two families (75 children) were eligible and assigned in alternating order to receive (27 families, 39 children) or not to receive (25
families, 36 children) the intervention. Intervention efficacy was evaluated as change in children's symptoms of anxiety, depression, posttraumatic
stress, social adjustment, and parents' depressive symptoms from initial to outcome assessments.\r\rResults\rChanges in anxiety and depressive
symptoms were significantly greater among children who received the intervention than in those who did not. A greater dropout of children assigned
not to receive (75%) than to receive (18%) intervention led to an imbalance in retention of intervention and nonintervention participants.\r
\rConclusions\rA bereavement group intervention focusing on reactions to death and suicide and strengthening coping skills can lessen distress of
children bereaved after parental or sibling suicide. Such intervention may prevent future morbidities.
Journal of the American Academy
of Child & Adolescent Psychiatry, 41(5) : 505-513
- Year: 2002
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Michael, Kurt
D., Crowley, Susan L.
We located a
comprehensive sample of studies (1980-1999) on the psychosocial and pharmacological treatment of child and adolescent depression through an extensive
literature search. Articles that met the inclusionary criteria were subsequently analyzed. The outcome data from 38 studies were extracted and
converted into effect sizes (ESs). Comparisons of main effects, demographic, and quality of study variables were conducted. The overall findings of
this meta-analysis indicate that several different psychosocial interventions for child and adolescent depression produced moderate to large
treatment gains that were clinically meaningful for many afflicted youth. However, in general, the vast majority of pharmacological interventions
were not effective in treating depressed children and adolescents. Nonetheless, there is recent evidence that selective serotonin reuptake inhibitors
(SSRIs) such as fluoxetine are efficacious, and will likely play an increased role in the management of affective illness in youngsters. The clinical
implications and limitations of these data are discussed and suggestions for future research are provided. [References: 112]
Clinical Psychology Review, 22(2) : 247-
69
- Year: 2002
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Emslie, Graham J., Heiligenstein, John H., Wagner, Karen
Dineen, Hoog, Sharon L., Ernest, Daniel E., Brown, Eileen, Nilsson, Mary, Jacobsen, Jennie G.
Presents results from the acute treatment phase of a clinical trial designed to confirm efficacy of a
fixed dose of 20 mg of fluoxetine in 122 children and 97 adolescents with major depressive disorder (MDD). After a 1-week placebo lead-in,
fluoxetine-treated patients received fluoxetine 10 mg/day for 1 week, then fluoxetine 20 mg/day for 8 weeks. Fluoxetine was associated with greater
mean improvement in Children's Depression Rating Scale-Revised (CDRS-R) score than placebo after 1 week and throughout the study period.
Significantly more fluoxetine-treated patients (41%) met the prospectively defined criteria for remission than did placebo-treated patients (20%).
More fluoxetine- (65%) than placebo-treated (53%) patients met the prospectively defined response criterion of >=30% decrease in CDRS-R score, but
this difference was not significant. Significantly more fluoxetine- than placebo-treated patients completed acute treatment. There were no
significant differences between treatment groups in discontinuations due to adverse events. Fluoxetine 20 mg daily appears to be well tolerated and
effective for acute treatment of MDD in child and adolescent outpatients. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Journal of the American Academy of Child & Adolescent Psychiatry, 41(10) : 1205-
1214
- Year: 2002
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Diamond, Guy S., Reis, Brendali F., Diamond, Gary M., Siqueland, Lynne, Isaacs, Lisa
OBJECTIVE: To design a treatment manual and adherence measure for attachment-based family therapy (ABFT) for adolescent depression and
to collect pilot data on the treatment's efficacy. METHOD: Over a period of 2 years, 32 adolescents meeting criteria for major depressive disorder
(MDD) were randomly assigned to 12 weeks of ABFT or a 6-week, minimal-contact, waitlist control group. The sample was 78% female and 69% African
American; 69% were from low-income, inner-city communities. RESULTS: At post-treatment, 81% of the patients treated with ABFT no longer met criteria
for MDD, in contrast with 47% of patients in the waitlist group. Mixed factorial analyses of variance revealed that, compared with the waitlist
group, patients treated with ABFT showed a significantly greater reduction in both depressive and anxiety symptoms and family conflict. Of the 15
treated cases assessed at the follow-up, 13 patients (87%) continued to not meet criteria for MDD 6 months after treatment ended. CONCLUSIONS: ABFT
appears to be a promising treatment and worthy of further development.
Journal of the American Academy of Child & Adolescent Psychiatry, 41(10) : 1190-
6
- Year: 2002
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Weersing, V., Weisz, John R.
This study used a benchmarking strategy to evaluate
the effectiveness of community psychotherapy for depressed youth relative to evidence-based treatment in clinical trials. Symptom trajectories of
depressed youth treated in community mental health centers (CMHCs) were compared with trajectories of youth treated with cognitive-behavioral therapy
(CBT) in clinical trials. Overall, outcomes of CMHC youth more closely resembled those of control condition youth than youth treated with CBT. Within
the CMHC sample, ethnic minority status and low therapy dose were related to worse outcomes. However, when outcomes for Caucasian youth and youth
receiving longer term services were examined, the CMHC sample still performed more poorly than youth treated with CBT. The findings support the value
of developing, testing, and exporting effective therapies for depressed youth to community clinic settings. (PsycINFO Database Record (c) 2007 APA,
all rights reserved).
Journal of Consulting & Clinical Psychology, 70(2) : 299-
310
- Year: 2002
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Yu, David Lei, Seligman,
Martin E.
Posted 5/8/2002. Three studies reported on depressive symptoms (DSs) in mainland Chinese children. Study 1 showed that DSs were widely
present in Chinese children. There were more symptoms in boys, in younger children, in children of less educated and less wealthy parents, in
children from multi-child families, in children from single-parent families, in children from families in turmoil, and in children with lower
academic achievement and conduct problems. In Study 2, 185 Chinese children in Beijing were followed for 8 months. A pessimistic explanatory style
was associated with higher concurrent levels of DSs and higher levels at subsequent tests as well. There was strong evidence that the interaction of
a pessimistic explanatory style and negative life events predicted higher levels of future DSs. In Study 3, we implemented an \"optimistic child\"
type intervention program for 220 Chinese children who were selected from 1,425 students based on DSs and family conflict and were randomly assigned
to the intervention group or the control group. At the post-test and the 3- and 6-month follow-ups, children who participated in the intervention
program showed significantly fewer DSs. A more optimistic explanatory style mediated the prevention of depressive symptoms. . . . (PsycINFO Database
Record (c) 2007 APA, all rights reserved).
Prevention & Treatment, 5(1) :
- Year: 2002
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions