Disorders - Depressive Disorders
March, J., Silva, S., Curry, J., Wells, K., Fairbank, J., Burns, B., Domino, M., Vitiello, B., et-al
Objective: The Treatment for Adolescents With Depression Study (TADS) evaluates the effectiveness of fluoxetine, cognitive-behavioral therapy (CBT), and their combination in adolescents with major depressive disorder. The authors report effectiveness outcomes across a 1-year naturalistic follow-up period. Method: The randomized, controlled trial was conducted in 13 academic and community sites in the United States. Stages I, II, and III consisted of 12, 6, and 18 weeks of acute, consolidation, and continuation treatment, respectively. Following discontinuation of TADS treatments at the end of stage III, stage IV consisted of 1 year of naturalistic follow-up. The participants were 327 subjects between the ages of 12 and 17 with a primary DSM-IV diagnosis of major depressive disorder. No TADS treatment was provided during the follow-up period; treatment was available in the community. The primary dependent measures, rated by an independent evaluator blind to treatment status, were the total score on the Children's Depression Rating Scale - Revised and the rate of response, defined as a rating of much or very much improved on the Clinical Global Impressions improvement measure. Results: Sixty-six percent of the eligible subjects participated in at least one stage IV assessment. The benefits seen at the end of active treatment (week 36) persisted during follow-up on all measures of depression and suicidality. Conclusions: In contrast to earlier reports on short-term treatments, in which worsening after treatment is the rule, the longer treatment in the TADS was associated with persistent benefits over 1 year of naturalistic follow-up.
American Journal of Psychiatry, 166(10) : 1141-1149
- Year: 2009
- 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)
Hamdan-Mansour, A. M., Puskar, K., Bandak, A. G.
The study examined the effectiveness of cognitive behavioral therapy (CBT) with university students suffering from moderate to severe depressive symptoms in Jordan. Eighty-four university students were recruited and assigned randomly to control and intervention groups. Intervention impact was assessed on measures of depressive symptoms, perceived stress, and coping strategies at three time points; baseline, postintervention, and 3-months postintervention. The interventional model used was the Modified Teaching Kids to Cope (MTKC), and the control group received no treatment. Overall, using CBT showed a significant improvement in the outcome measures. At postintervention, students had lower scores on perceived stress, lower depressive symptoms, less use of avoidance coping strategies, and more use of approach coping strategies. The findings are discussed in terms of treatment implications and recommendations for use at academic and health care settings.
Issues in Mental Health Nursing, 30(3) : 188-196
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Hoek, Willemijn, Schuurmans, Josien, Koot, Hans M., Cuijpers, Pim
Background: Methods/design: Discussion: Trial Registration: Even though depression and anxiety are highly prevalent in adolescence, youngsters are not inclined to seek help in regular healthcare. Therapy through the Internet, however, has been found to appeal strongly to young people. The main aim of the present study is to examine the efficacy of preventive Internet-based guided self-help problem-solving therapy with adolescents reporting depressive and anxiety symptoms. A secondary objective is to test potential mediating and moderating variables in order to gain insight into how the intervention works and for whom it works best.This study is a randomized controlled trial with an intervention condition group and a wait-list control group. The intervention condition group receives Internet-based self-help problem-solving therapy. Support is provided by a professional and delivered through email. Participants in the wait-list control group receive the intervention four months later. The study population consists of adolescents (12-18-year-olds) from the general population who report mild to moderate depressive and/or anxiety symptoms and are willing to complete a self-help course. Primary outcomes are symptoms of depression and anxiety. Secondary outcomes are quality of life, social anxiety, and cost-effectiveness. The following variables are examined for their moderating role: demographics, motivation, treatment credibility and expectancy, externalizing behaviour, perceived social support from parents and friends, substance use, the experience of important life events, physical activity, the quality of the therapeutic alliance, and satisfaction. Mediator variables include problem-solving skills, worrying, mastery, and self-esteem. Data are collected at baseline and at 3 weeks, 5 weeks, 4 months, 8 months, and 12 months after baseline. Both intention-to-treat and completer analyses will be conducted.This study evaluates the efficacy and mechanisms of Internet-based problem-solving therapy for adolescents. If Internet-based problem-solving therapy is shown to reduce depressive and anxiety symptoms in adolescents, the implication is to implement the intervention in clinical practice. Strengths and limitations of the study are discussed.Netherlands Trial Register NTR1322.
Trials, 10 : 93-93
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Problem solving therapy (PST)
, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
Garber, Judy, Clarke, Gregory N., Weersing, V. Robin, Beardslee, William R., Brent, David A., Gladstone, Tracy R. G., DeBar, Lynn L., Lynch, Frances L., D'Angelo, Eugene, Hollon, Steven D., Shamseddeen, Wael, Iyengar, Satish
Context: Objective: Design, Setting, and Participants: Intervention: Main Outcome Measure: Results: Conclusion: Trial Registration: Adolescent offspring of depressed parents are at markedly increased risk of developing depressive disorders. Although some smaller targeted prevention trials have found that depression risk can be reduced, these results have yet to be replicated and extended to large-scale, at-risk populations in different settings.To determine the effects of a group cognitive behavioral (CB) prevention program compared with usual care in preventing the onset of depression.A multicenter randomized controlled trial conducted in 4 US cities in which 316 adolescent (aged 13-17 years) offspring of parents with current or prior depressive disorders were recruited from August 2003 through February 2006. Adolescents had a past history of depression, current elevated but subdiagnostic depressive symptoms, or both. Assessments were conducted at baseline, after the 8-week intervention, and after the 6-month continuation phase.Adolescents were randomly assigned to the CB prevention program consisting of 8 weekly, 90-minute group sessions followed by 6 monthly continuation sessions or assigned to receive usual care alone.Rate and hazard ratio (HR) of a probable or definite depressive episode (ie, depressive symptom rating score of > or = 4) for at least 2 weeks as diagnosed by clinical interviewers.Through the postcontinuation session follow-up, the rate and HR of incident depressive episodes were lower for those in the CB prevention program than for those in usual care (21.4% vs 32.7%; HR, 0.63; 95% confidence interval [CI], 0.40-0.98). Adolescents in the CB prevention program also showed significantly greater improvement in self-reported depressive symptoms than those in usual care (coefficient, -1.1; z = -2.2; P = .03). Current parental depression at baseline moderated intervention effects (HR, 5.98; 95% CI, 2.29-15.58; P = .001). Among adolescents whose parents were not depressed at baseline, the CB prevention program was more effective in preventing onset of depression than usual care (11.7% vs 40.5%; HR, 0.24; 95% CI, 0.11-0.50), whereas for adolescents with a currently depressed parent, the CB prevention program was not more effective than usual care in preventing incident depression (31.2% vs 24.3%; HR, 1.43; 95% CI, 0.76-2.67).The CB prevention program had a significant prevention effect through the 9-month follow-up period based on both clinical diagnoses and self-reported depressive symptoms, but this effect was not evident for adolescents with a currently depressed parent.clinicaltrials.gov Identifier: NCT00073671.
JAMA, 301(21) : 2215-2224
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Cuijpers, Pim, Munoz, Ricardo F., Clarke, Gregory N., Lewinsohn, Peter M.
The "Coping with Depression" course (CWD) is by the far the best studied psychoeducational intervention for the treatment and prevention of depression, and is used in routine practice in several countries. The CWD is a highly structured cognitive-behavioral intervention, which has been adapted for several goals, contexts, and target populations. The efficacy of the CWD has been examined in 25 randomized controlled trials. We conducted a meta-analysis of these studies. The 6 studies aimed at the prevention of new cases of major depression were found to result in a reduced risk of getting major depression of 38% (incidence rate ratio was 0.62). The 18 studies examining the CWD as a treatment of depression found a mean effect size (Cohen's d) of 0.28. Direct comparisons with other psychotherapies did not result in any indication that the CWD was less efficacious. The CWD is a flexible treatment which can easily be adapted for different populations and this may have led researchers to use this intervention for complex target groups, which in turn may have resulted in a lower mean effect size. The CWD has contributed considerably to the development and innovation of prevention and treatment of depression in many target populations.
Clinical Psychology Review, 29(5) : 449-458
- Year: 2009
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation
Emslie, Graham J., Ventura, Daniel, Korotzer, Andrew, Tourkodimitris, Stavros
Objective: This article presents the results from a prospective, randomized, double-blind, placebo-controlled trial of escitalopram in adolescent patients with major depressive disorder. Method: Male and female adolescents (aged 12-17 years) with DSM-IV-defined major depressive disorder were randomly assigned to 8 weeks of double-blind treatment with escitalopram 10 to 20 mg/day (n = 155) or placebo (n = 157). The primary efficacy parameter was change from baseline to week 8 in Children's Depression Rating Scale-Revised (CDRS-R) score using the last observation carried forward approach. Results: A total of 83% patients (259/312) completed 8 weeks of double-blind treatment. Mean CDRS-R score at baseline was 57.6 for escitalopram and 56.0 for placebo. Significant improvement was seen in the escitalopram group relative to the placebo group at endpoint in CDRS-R score (-22.1 versus -18.8, p = .022; last observation carried forward). Adverse events occurring in at least 10% of escitalopram patients were headache, menstrual cramps, insomnia, and nausea; only influenza-like symptoms occurred in at least 5% of escitalopram patients and at least twice the incidence of placebo (7.1% versus 3.2%). Discontinuation rates due to adverse events were 2.6% for escitalopram and 0.6% for placebo. Serious adverse events were reported by 2.6% and 1.3% of escitalopram and placebo patients, respectively, and incidence of suicidality was similar for both groups. Conclusions: In this study, escitalopram was effective and well tolerated in the treatment of depressed adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Journal of the American Academy of Child & Adolescent Psychiatry, 48(7) : 721-729
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Findling, R. L., Pagano, M. E., McNamara, N. K., Stansbrey, R. J., Faber, J. E., Lingler, J., Demeter, C. A., et-al
Background: The objective of this study was to examine whether fluoxetine was superior to placebo in the acute amelioration of depressive symptomatology in adolescents with depressive illness and a comorbid substance use disorder. Methods: Eligible subjects ages 12-17 years with either a current major depressive disorder (MDD) or a depressive disorder that were also suffering from a comorbid substance-related disorder were randomized to receive either fluoxetine or placebo in this single site, 8-week double-blind, placebo-controlled study. The primary outcome analysis was a random effects mixed model for repeated measurements of Children's Depression Rating Scale-Revised (CDRS-R) scores compared between treatment groups across time. Results: An interim analysis was performed after 34 patients were randomized. Based on the results of a futility analysis, study enrollment was halted. Twenty-nine males and 5 females were randomized to receive fluoxetine (n = 18) or placebo (n = 16). Their mean age was 16.5 (1.1) years. Overall, patients who received fluoxetine and placebo had a reduction in CDRS-R scores. However, there was no significant difference in mean change in CDRS-R total score in those subjects treated with fluoxetine and those who received placebo (treatment difference = 0.19, S.E. = 0.58, F = 0.14, p = .74). Furthermore, there was not a significant difference in rates of positive urine drug toxicology results between treatment groups at any post-randomization visit (F = 0.22, df = 1, p = 0.65). The main limitation of this study is its modest sample size and resulting low statistical power. Other significant limitations to this study include, but are not limited to, the brevity of the trial, high placebo response rate, limited dose range of fluoxetine, and the inclusion of youth who met criteria for depressive disorders other than MDD. Conclusion: Fluoxetine was not superior to placebo in alleviating depressive symptoms or in decreasing rates of positive drug screens in the acute treatment of adolescents with depression and a concomitant substance use disorder. (copyright) 2009 Findling et al; licensee BioMed Central Ltd.
Child & Adolescent Psychiatry & Mental Health, 3 :
- Year: 2009
- Problem: Depressive Disorders, Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Cornelius, Jack R., Bukstein, Oscar G., Wood, D. Scott, Kirisci, Levent, Douaihy, Antoine, Clark, Duncan B.
Objective: This study compared the acute phase (12-week) efficacy of fluoxetine versus placebo for the treatment of the depressive symptoms and the drinking of adolescents with comorbid major depression (MDD) and an alcohol use disorder (AUD). We hypothesized that fluoxetine would demonstrate efficacy versus placebo for the treatment of both the depressive symptoms and the drinking of comorbid MDD/AUD adolescents. Methods: We conducted the first double-blind placebo-controlled study of fluoxetine in adolescents with comorbid MDD/AUD. All participants in both treatment groups also received intensive manual-based Cognitive Behavioral Therapy (CBT) and Motivation Enhancement Therapy (MET). Results: Fluoxetine was well tolerated in this treatment population. No significant group-by-time interactions were noted for any depression-related or drinking-related outcome variable. Subjects in both the fluoxetine group and the placebo group showed significant within-group improvement in both depressive symptoms and level of alcohol consumption. End-of-study levels of depression and drinking were low in both treatment groups. Conclusions: The lack of a significant between-group difference in depressive symptoms and in drinking may reflect limited medication efficacy, or may result from limited sample size or from efficacy of the CBT/MET psychotherapy. Large multi-site studies are warranted to further clarify the efficacy of SSRI medications in this adolescent MDD/AUD population. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Addictive Behaviors, 34(10) : 905-909
- Year: 2009
- Problem: Depressive Disorders, Alcohol Use
- 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)
, Motivational interviewing, includes Motivational Enhancing Therapy
Clarke, Greg, Kelleher, Chris, Hornbrook, Matt, DeBar, Lynn, Dickerson, John, Gullion, Christina,
This study evaluated an Internet-delivered, cognitive behavioral skills training program versus a treatment-as-usual (TAU) control condition targeting depression symptoms in young adults aged 18 to 24 years. Potential participants were mailed a recruitment brochure; if interested, they accessed the study website to complete an online consent and baseline assessment. Intervention participants could access the website at their own pace and at any time. Reminder postcards were mailed periodically to encourage return use of the intervention. The pure self-help intervention was delivered without contact with a live therapist. The primary depression outcome measure was the Patient Health Questionnaire, administered at 0, 5, 10, 16, and 32 weeks after enrollment. A small but significant between-group effect was found from Week 0 to Week 32 for the entire sample (N = 160, d = .20, 95% confidence interval [CI] 0.00-0.50), with a moderate effect among women (n = 128, d .42, 95% C1 = 0.09-0.77). Greater depression reduction was associated with two measures of lower website usage, total minutes, and total number of page hits. Although intervention effects were modest, they were observed against a background of substantial TAU depression pharmacotherapy and psychosocial services. Highly disseminable, low-cost, and self-help interventions such as this have the potential to deliver a significant public health benefit. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Cognitive Behaviour Therapy, 38(4) : 222-234
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
Brunwasser, Steven M., Gillham, Jane E., Kim, Eric S.
The purpose of this review was to evaluate whether the Penn Resiliency Program (PRP), a group cognitive-behavioral intervention, is effective in targeting depressive symptoms in youths. We identified 17 controlled evaluations of PRP (N = 2,498) in which depressive symptoms had been measured via an online search of PsycINFO, Medline, ERIC, and ProQuest Dissertations and Theses and by requesting data from PRP researchers. We combined effect sizes (ESs; Glass's d), using random effects models at postintervention and two follow-up assessments (6-8 and 12 months postintervention). PRP participants reported fewer depressive symptoms at postintervention and both follow-up assessments compared with youths receiving no intervention, with ESs ranging from 0.11 to 0.21. Subgroup analyses showed that PRP's effects were significant at 1 or more follow-up assessments among studies with both targeted and universal approaches, when group leaders were research team members and community providers, among participants with both low and elevated baseline symptoms, and among boys and girls. Limited data showed no evidence that PRP is superior to active control conditions. Preliminary analyses suggested that PRP's effects on depressive disorders may be smaller than those reported in a larger meta-analysis of depression prevention programs for older adolescents and adults. We found evidence that PRP significantly reduces depressive symptoms through at least 1-year postintervention. Future PRP research should examine whether PRP's effects on depressive symptoms lead to clinically meaningful benefits for its participants, whether the program is cost-effective, whether CB skills mediate program effects, and whether PRP is effective when delivered under real-world conditions.
Journal of Consulting & Clinical Psychology, 77(6) : 1042-1054
- Year: 2009
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Chu, I. Hua, Buckworth, Janet, Kirby, Timothy E., Emery, Charles F.
Exercise has been shown to relieve depressive symptoms, yet optimal exercise intensity for treating depression has not been established. The mechanisms that explain the antidepressant effect of exercise also require investigation. The purpose of this study was to test (a) the effect of two different exercise intensities prescribed for aerobic training on depressive symptoms, and (b) a previously proposed psychological mechanism for this effect: self-efficacy. Sedentary women scoring ≥14 on the Beck Depression Inventory-II (BDI-II) were randomized to one of two aerobic training groups that differed on exercise intensity (high [65 - 75% MaxVOâ‚‚ reserve] or low [40 - 55% MaxVOâ‚‚ reserve]), or to a stretching control group for 10 weeks. Main outcome variables included depressive symptoms (BDI-II) and self-efficacy (exercise self-efficacy [ESE] and depression coping self-efficacy [DCSE]), which were measured at study entry, 5 and 10 weeks later. Participants in all groups (high, n = 18; low, n = 18; stretching, n = 18) had significant reductions in depressive symptoms at Week 5 (p < .001) and Week 10 (p < .001). The BDI-II change scores did not differ significantly among the groups (p = .066). Follow-up analyses controlling for baseline BDI-II scores showed that the high intensity group had significantly fewer depressive symptoms than the low intensity and stretching control groups at weeks 5 and 10 (p < .05). There was no significant association between changes in aerobic capacity and changes in depressive symptoms (r = âˆ'.099, p = .491). At 10 weeks, both ESE (p = .013) and DCSE (p < .001) increased significantly for the whole sample, with no significant group difference (p = .613 for ESE, p = .277 for DCSE). Controlling for baseline scores, the increase remained significant for ESE (p = .005) but not for DCSE (p = .629). Partial correlations showed significant negative relationships between both types of self-efficacy and depressive symptoms at Week 5 and Week 10 (p < .02). We concluded that both high and low intensity aerobic exercise, as well as stretching exercise were associated with reductions in mild to moderate depressive symptoms in initially sedentary women. Changes in depression were associated with changes in ESE and DCSE. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Mental Health & Physical Activity, 2(1) : 37-43
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Physical activity, exercise
Calear, Alison L., Christensen, Helen, Mackinnon, Andrew, Griffiths, Kathleen M., O'Kearney, Richard
The aim in the current study was to investigate the effectiveness of an online, self-directed cognitive–behavioral therapy program (MoodGYM) in preventing and reducing the symptoms of anxiety and depression in an adolescent school-based population. A cluster randomized controlled trial was conducted with 30 schools (N = 1,477) from across Australia, with each school randomly allocated to the intervention or wait-list control condition. At postintervention and 6-month follow-up, participants in the intervention condition had significantly lower levels of anxiety than did participants in the wait-list control condition (Cohen’s d = 0.15–0.25). The effects of the MoodGYM program on depressive symptoms were less strong, with only male participants in the intervention condition exhibiting significant reductions in depressive symptoms at postintervention and 6-month follow-up (Cohen’s d = 0.27–0.43). Although small to moderate, the effects obtained in the current study provide support for the utility of universal prevention programs in schools. The effectiveness of booster sessions should be explored in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Journal of Consulting & Clinical Psychology, 77(6) : 1021-1032
- Year: 2009
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)