Disorders - Depressive Disorders
Fristad, Mary A., Verducci, Joseph S., Walters, Kimberly, Young, Matthew E.
Context: Childhood mood disorders lack sufficient evidence- based treatments. While psychosocial treatments are recommended for both childhood depression and bipolar disorder, empirical support is scarce. Objective: To determine whether adjunctive multifamily psychoeducational psychotherapy would improve outcome for children aged 8 to 12 years with depression or bipolar disorder. Design: One hundred sixty-five children were studied in a randomized controlled trial of multifamily psychoeducational psychotherapy plus treatment as usual (n=78) compared with a wait-list control (WLC) condition plus treatment as usual (n=87). Assessments occurred at baseline and at 6, 12, and 18 months. Intervention occurred between baseline and 6 months for the immediate treatment group and between 12 and 18 months for the WLC group. Setting: University medical center. Participants: Children were recruited from mental health and physical health care providers, media contacts, and word of mouth. All had a major mood disorder (major depressive disorder or dysthymic disorder, 30%; bipolar disorder type I, type II, or not otherwise specified, 70%). Intervention: Children and 1 or more parents participated in eight 90-minute multifamily psychoeducational psychotherapy sessions. Parent and child groups met separately but began and ended sessions together. Main Outcome Measures: The Mood Severity Index (MSI) combines Mania Rating Scale and Children's Depression Rating Scale - Revised scores. Results: Multifamily psychoeducational psychotherapy plus treatment as usual was associated with lower MSI scores at follow-up in intent-to-treat analyses compared with WLC plus treatment as usual. The WLC group showed a similar decrease in MSI scores 1 year later, when also following their treatment. Conclusion: Brief, adjunctive psychoeducational group psychotherapy is associated with improved outcome for children aged 8 to 12 years with major mood disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Archives of General Psychiatry, 66(9) : 1013-1020
- Year: 2009
- Problem: Bipolar Disorders, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation
Khalsa, S. B. S., Shorter, S. M., Cope, S., Wyshak, G., Sklar, E.
Yoga and meditation can alleviate stress, anxiety, mood disturbance, and musculoskeletal problems, and can enhance cognitive and physical performance. Professional musicians experience high levels of stress, performance anxiety, and debilitating performance-related musculoskeletal disorders (PRMDs). The goal of this controlled study was to evaluate the benefits of yoga and meditation for musicians. Young adult professional musicians who volunteered to participate in a 2-month program of yoga and meditation were randomized to a yoga lifestyle intervention group (n = 15) or to a group practicing yoga and meditation only (n = 15). Additional musicians were recruited to a no-practice control group (n = 15). Both yoga groups attended three Kripalu Yoga or meditation classes each week. The yoga lifestyle group also experienced weekly group practice and discussion sessions as part of their more immersive treatment. All participants completed baseline and end-program self-report questionnaires that evaluated music performance anxiety, mood, PRMDs, perceived stress, and sleep quality; many participants later completed a 1-year followup assessment using the same questionnaires. Both yoga groups showed a trend towards less music performance anxiety and significantly less general anxiety/tension, depression, and anger at end-program relative to controls, but showed no changes in PRMDs, stress, or sleep. Similar results in the two yoga groups, despite psychosocial differences in their interventions, suggest that the yoga and meditation techniques themselves may have mediated the improvements. Our results suggest that yoga and meditation techniques can reduce performance anxiety and mood disturbance in young professional musicians. (copyright) 2009 Springer Science+Business Media, LLC.
Applied Psychophysiology Biofeedback, 34(4) : 279-289
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Meditation
, Mind-body exercises (e.g. yoga, tai chi, qigong)
Possel, P., Seemann, S., Hautzinger, M.
Despite the well-known relevance of comorbidity, few studies have examined the impact of comorbid anxiety or externalizing symptoms on the prevention of depressive symptoms in adolescents. To replicate earlier positive effects of a cognitive-behavioral prevention program of depressive symptoms and to test the hypothesis that the prevention program would be less effective in adolescents with comorbid anxiety and externalizing symptoms, the authors conducted a study involving 301 8th-grade students randomly divided into an intervention group and a nonintervention control group. The randomized design included baseline, postintervention, and 6-month follow-up. The prevention program included 10 sessions held in a regular school setting. The prevention program showed positive effects on depressive symptoms independent of comorbid symptoms. These effects were found mainly with girls independent of their depressive symptoms at baseline, and in part with boys with less severe depressive symptoms at baseline. It is surprising that negative effects of the prevention program on depressive symptoms were found on the depression of boys with more severe depressive symptoms at baseline. The prevention program's low rate of attrition and high recruitment rate support the generalizability of the results.
Journal of Counseling Psychology, 55(1) : 106-17
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Stice, E., Rohde, P., Seeley, J. R., Gau, J. M.
In this depression prevention trial, 341 high-risk adolescents (mean age = 15.6 years, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed significantly greater reductions in depressive symptoms than did supportive-expressive, bibliotherapy, and assessment-only participants at posttest, though only the difference compared with assessment controls was significant at 6-month follow-up. CB participants showed significantly greater improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than did participants in all 3 other conditions. Supportive-expressive and bibliotherapy participants showed greater reductions in depressive symptoms than did assessment-only controls at certain follow-up assessments but produced no effects for social adjustment and substance use. CB, supportive-expressive, and bibliotherapy participants showed a significantly lower risk for major depression onset over the 6-month follow-up than did assessment-only controls. The evidence that this brief CB intervention reduced risk for future depression onset and outperformed alternative interventions for certain ecologically important outcomes suggests that this intervention may have clinical utility. (copyright) 2008 American Psychological Association.
Journal of Consulting & Clinical Psychology, 76(4) : 595-606
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Supportive therapy, Self-help
Tsapakis, E. M., Soldani, F., Tondo, L., Baldessarini, R. J.
Background: The safety of antidepressants in children and adolescents is being questioned and the efficacy of these drugs in juvenile depression remains uncertain. Aims: To assess antidepressant efficacy in juvenile depression. Method: Systematic review and meta-analysis of randomised controlled trials (RCTs) comparing responses to antidepressants, overall and by type, v. placebo in young people with depression. Results: Thirty drug-placebo contrasts in RCTs lasting 8 weeks (median) involved 3069 participants (512 person-years) of average age 13.5 years. Meta-analysis yielded a modest pooled drug/placebo response rate ratio (RR=1.22, 95% CI 1.15-1.31), with little separation between antidepressant types. Findings were similar for response rate differences and corresponding number needed to treat (NNT): overall NNT=9; tricyclic antidepressants NNT=14 > serotonin reuptake inhibitors NNT=9 > other antidepressants NNT=8. Numbers needed to treat decreased with increasing age: children (NNT=21) > mixed ages (NNT=10) > adolescents (NNT=8). Conclusions: Antidepressants of all types showed limited efficacy in juvenile depression, but fluoxetine might be more effective, especially in adolescents. Studies in children and in severely depressed, hospitalised or suicidal juvenile patients are needed, and effective, safe and readily accessible treatments for juvenile depression are urgently required.
British Journal of Psychiatry, 193(1) : 10-17
- Year: 2008
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Antidepressants (any)
Usala, T., Clavenna, A., Zuddas, A., Bonati, M.
To evaluate the efficacy of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents with depressive disorder, the main electronic databases and the reference lists of retrieved articles and reviews were searched up to January 2007. Randomized controlled studies (RCT) were assessed for methodological quality, taking into consideration the specific diagnostic and severity evaluation tools used, and a meta-analysis on the efficacy of SSRIs compared placebo was undertaken. In all, 13 studies were included, covering a total of 2530 children and adolescents. Eleven studies met the criteria for inclusion in the meta-analysis. The pooled odds ratio was 1.57 (95% C.I. 1.29-1.91). Only fluoxetine appeared to offer a moderately significant benefit profile (OR = 2.39). All studies differed in diagnostic tools and primary efficacy measures. SSRI treatment, especially with fluoxetine, may be effective on child and adolescent depression. Nevertheless, additional RCTs with sound methodological designs, validated diagnostic instruments, large sample sizes, and consistent outcomes are necessary to determine the role of SSRIs, alone or in combination with psychological interventions in the treatment of depression in children and adolescents. (copyright) 2007 Elsevier B.V. and ECNP.
European Neuropsychopharmacology, 18(1) : 62-73
- Year: 2008
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
VanVoorhees, B. W., Vanderplough-Booth, K., Fogel, J., Gladstone, T., Bell, C., Stuart, S., Gollan, J., et-al
Background: Adolescent depression is both a major public health and clinical problem, yet primary care physicians have limited intervention options. We developed two versions of an Internet-based behavioral intervention to prevent the onset of major depression and compared them in a randomized clinical trial in 13 US primary care practices. Methods: We enrolled 84 adolescents at risk for developing major depression and randomly assigned them to two groups: brief advice (BA; 1-2 minutes) + Internet program versus motivational interview (MI; 5-15 minutes) + Internet program. We compared pre/post changes and between group differences for protective and vulnerability factors (individual, family, school and peer). Results: Compared with pre-study values, both groups demonstrated declines in depressed mood; [MI: 21.2 to 16.74 (p < 0.01), BA: 23.34 to 16.92 (p < 0.001)]. Similarly, both groups demonstrated increases in social support by peers [MI: 8.6 to 12.1 (p = 0.002), BA: 7.10 to 12.5 (p < 0.001)] and reductions in depression related impairment in school [MI: 2.26 to 1.76 (p = 0.06), BA: 2.16 to 1.93 (p = 0.07)]. Conclusions: Two forms of a primary care/Internet-based behavioral intervention to prevent adolescent depression may lower depressed mood and strengthen some protective factors for depression.
Journal of the Canadian Academy of Child & Adolescent Psychiatry, 17(4) : 184-196
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Vuori, J., Koivisto, P., Mutanen, P., Jokisaari, M., Salmela-Aro, K.
The Towards Working Life group method was designed to promote the transition to the upper secondary level or vocational studies and to support mental health among young people finishing their basic education. This study examined the effects of the intervention during upper secondary and vocational studies in a randomized field experimental study among a total of 1034 students. At the one-year follow-up, the program had increased both education related social ties and the number of adults in these ties. The group intervention had interaction effects with baseline risk of depression and learning difficulties on symptoms of depression and school burnout. Among those initially at risk of depression, the intervention decreased symptoms of depression. For students who were at risk of depression and had learning difficulties, the intervention decreased school burnout.
, 72(1) : 67-80
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational interventions
Wilkinson, P. O., Goodyer, I. M.
Background: A mood-related ruminative response style increases the risk of onset and persistence of depression. This preliminary study investigated whether, in depressed adolescents, cognitive-behaviour therapy reduces mood-related ruminative response style. Whether specific factors within the rumination scale were differentially affected by CBT is also reported. Methods: 26 depressed adolescents were randomised to receiving serotonin-specific reuptake inhibitor antidepressants (SSRI) plus psychosocial treatment as usual or SSRI and psychosocial treatment as usual plus CBT. Ruminative response style and depressive symptoms were measured at baseline and after 30 weeks of treatment, with the Responses to Depression Questionnaire and Mood and Feelings Questionnaire. Results: There were significantly greater reductions in ruminations in the CBT group compared to the non-CBT group (p = .002). There was no significant difference in the reduction in self-reported depressive symptoms between the groups. Rumination was reduced to levels of never-depressed controls in adolescents who had recovered from depression and received CBT. There were greater falls in the CBT group in the more pathological 'brooding' factor of rumination. Conclusion: These findings suggest that adding CBT to SSRI medication in the presence of active clinical care causes a greater reduction in mood-related ruminative response style in depressed adolescents. This may reduce the risk of future relapse. (copyright) 2008 Wilkinson and Goodyer; licensee BioMed Central Ltd.
Child & Adolescent Psychiatry & Mental Health, 2 :
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Rohde, P., Silva, S. G., Tonev, S. T., Kennard, B. D., Vitiello, B., Kratochvil, C. J., Reinecke, M. A., Curry, J. F., Simons, A. D., March, J. S.
Context: The Treatment for Adolescents With Depression Study evaluated fluoxetine (FLX), cognitive behavioral therapy (CBT), and FLX/CBT combination (COMB) vs pill placebo in 439 adolescents with major depressive disorder. Treatment consisted of 3 stages: (1) acute (12 weeks), (2) continuation (6 weeks), and (3) maintenance (18 weeks). Objective: To examine rates of achieving and maintaining sustained response during continuation and maintenance treatments. Design: Randomized controlled trial. Response was determined by blinded independent evaluators. Setting: Thirteen US sites. Patients: Two hundred forty-two FLX, CBT, and COMB patients in their assigned treatment at the end of stage 1. Interventions: Stage 2 treatment varied based on stage 1 response. Stage 3 consisted of 3 CBT and/or pharmacotherapy sessions and, if applicable, continued medication. Main Outcome Measures: Sustained response was defined as 2 consecutive Clinical Global Impression-Improvement ratings of 1 or 2 ("full response"). Patients achieving sustained response were classified on subsequent nonresponse status. Results: Among 95 patients (39.3%) who had not achieved sustained response by week 12 (29.1% COMB, 32.5% FLX, and 57.9% CBT), sustained response rates during stages 2 and 3 were 80.0% COMB, 61.5% FLX, and 77.3% CBT (difference not significant). Among the remaining 147 patients (60.7%) who achieved sustained response by week 12, CBT patients were more likely than FLX patients to maintain sustained response through week 36 (96.9% vs 74.1%; P=.007; 88.5% of COMB patients maintained sustained response through week 36). Total rates of sustained response by week 36 were 88.4% COMB, 82.5% FLX, and 75.0% CBT. Conclusions: Most adolescents with depression who had not achieved sustained response during acute treatment did achieve that level of improvement during continuation and maintenance therapies. The possibility that CBT may help the subset of adolescents with depression who achieve early sustained response maintain their response warrants further investigation. Trial Registration: clinicaltrials.gov Identifier: NCT00006286. (copyright)2008 American Medical Association. All rights reserved.
Archives of General Psychiatry, 65(4) : 447-455
- Year: 2008
- 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)
Rossello, J., Bernal, G., Rivera-Medina, C.
This study compared individual (I) to group (G) formats of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for the treatment of depression in adolescents. One hundred and 12 Puerto Rican adolescents were randomized to four conditions (CBT-I, CBT-G, IPT-I, IPT-G). Participants were assessed at pretreatment and posttreatment with structured interviews to establish diagnosis and with self-report measures to assess treatment outcome. The results suggest that CBT and IPT are robust treatments in both group and individual formats. However, CBT produced significantly greater decreases in depressive symptoms and improved self-concept than IPT. The implications of these findings are discussed. (copyright) 2008 American Psychological Association.
Cultural Diversity & Ethnic Minority Psychology, 14(3) : 234-245
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Interpersonal therapy (IPT)
America, A., Milling, L. S.
Over-the-counter vitamins have become increasingly popular as a natural remedy for reducing or preventing depression symptoms and enhancing the emotional well-being of healthy individuals in the general population. This placebo-controlled, single-blind trial evaluated the effect of vitamins on depression symptoms experienced by a nonclinical sample of participants. One hundred and fourteen healthy young adults were randomly assigned to multivitamin, B-complex vitamin, placebo vitamin, or no-treatment control conditions. At the end of a 6-week regimen, participants administered vitamins reported significant reductions in depression symptoms as measured by the Beck Depression Inventory compared to those who received no treatment. There was no difference between the multivitamin, the B-vitamin, and the placebo. The effect of each of the vitamin regimens on depression symptoms was partially mediated by response expectancies. The results do not support the efficacy of vitamins as a natural remedy for reducing or preventing depression symptoms among healthy people in the general population. (copyright) 2007 Springer Science+Business Media, LLC.
Journal of Behavioral Medicine, 31(2) : 157-167
- Year: 2008
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Vitamins and supplements