Disorders - Depressive Disorders
Attari, A., Moghaddam, Y., Hasanzadeh, A., Soltani, M., Mahmoodi, M.
Background: The incidence of depression is 0.9% in preschoolers, 1.9% in school age children, and 4.7% in adolescents. Current antidepressant treatment of mood disorders in children and adolescents is still in the early phases of being validated with double-blind efficacy studies. In this study the efficacy of nortriptyline has been compared with fluoxetine in the treatment of major depression in children and adolescents. Methods: This was a double-blind clinical trial for 8 weeks, undertaken in the Isfahan Child and Adolescent Guidance outpatient Clinic, Isfahan, Iran. Subjects were 40 outpatients children and adolescents (20 boys and 20 girls) aged 7-16 years of old who met the Diagnostic and Statistical Manual of Mental Disorders, Forth Edition, for Major Depression. To determine the scores of two groups (Baseline and after treatment), we used Children Depression Inventory (CDI). Subjects were randomly assigned to receive nortriptyline 2mg/kg/day for 8 weeks (group A) or fluoxetine 1mg/kg/day for 8 weeks, (group B). Paired t-test was used to compare the mean of CDI score of each group before and after treatment. To compare the reduction in the Children Depression Inventory score, an unpaired t-test was used. Results: The mean depression score was 28.9 (SD+/-8.46) before intervention in fluoxetine group while that was 28.4 (SD+/-8.76) in nortriptyline group. Independent t-test showed a significant difference between after treatment mean depression scores in both groups (t=2.97, df=38, P=0.004). The changes at the endpoint compared with baseline were - 10.95+/-2.61 and -2.6+/-0.8 for fluoxetine and nortriptyline, respectively. t- Paired test showed a significant decrease in mean depression score in fluoxetine group (P[less-than or equal to]0.0001) while that was not significant one in nortriptyline group (P=0.34). At the endpoint (8th week), 10 cases 50% didn't meet the criteria of Major Depression based on DSM-IV in fluoxetine group. Although, it was only 2 cases (10%) for nortriptyline group. Conclusion: The present study suggest that the treatment with fluoxetine in subsiding depression was significantly preferable compared with nortriptyline. The general conclusion of this study provides evidence in favor of an efficacy advantage of fluoxetine over nortriptyline in the treatment of depression in children and adolescents.
Journal of Research in Medical Sciences, 11(1) : 24-30
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants
Castellanos, N., Conrod, P.
Background: Personality-targeted cognitive-behavioural interventions have been proven to be effective in reducing alcohol-related behaviours in adolescents. Aims: As these interventions target personality traits linked to risk for non-addictive psychopathology, the aim of this study is to examine the extent to which this approach can also prevent the onset or reduce relevant psychological problems in youth. Method: Participants aged 13-16 years (n=423) were randomly assigned to either a personality matched cognitive-behavioural intervention or a no-intervention control. The personality matched interventions targeted four personality risk factors: negative thinking (NT), anxiety sensitivity (AS), impulsivity (IMP), and sensation seeking (SS). Results: Baseline and follow-up data were obtained on depression scores, panic attacks, and reckless behaviour. Results showed a moderate effect of the NT intervention on depression scores, and a similar effect of the AS intervention on panic attack and truancy (i.e., school avoidance). A small but significant intervention effect was found for shoplifting for the entire sample, as well as a moderate intervention effect on this outcome for the IMP intervention group. Conclusions: These intervention effects indicate that personality-targeted interventions designed to prevent alcohol misuse, can concurrently reduce other relevant psychological problems in youth. copyright Shadowfax Publishing and Informa UK Ltd.
Journal of Mental Health & Aging, 15(6) : 645-658
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Berard, Ray, Fong, Regan, Carpenter, David J., Thomason, Christine, Wilkinson, Christel
OBJECTIVE: The aim of this study was to examine the efficacy, safety, and tolerability of paroxetine in adolescents with unipolar major depression. METHOD: Two hundred eighty-six (286) adolescents with unipolar major depression were randomly assigned to receive either paroxetine or placebo for 12 weeks. RESULTS: The proportion of Montgomery-Asberg Depression Rating Scale (MADRS) responders (at least 50% reduction from baseline) for paroxetine and placebo were similar and not statistically different at endpoint (p = 0.702). A similar result was obtained for change from baseline on the Kiddie-Schedule for Affective Disorders and Schizophrenia for School- Age Children (K-SADS-L) depression subscale. Among secondary endpoints, only a significantly higher Clinical Global Impression-Improvement (CGI-I) response rate was reported in paroxetine-treated patients versus placebo (69.2% versus 57.3%; p = 0.045). In general, results differed by age, with patients older than 16 years demonstrating a greater response to active treatment. This age group also reported more adverse experiences (AEs) relative to placebo than younger adolescents. Overall, paroxetine was generally well tolerated (11% discontinued owing to an AE versus 7% of placebo-treated patients). A post hoc analysis of AEs related to suicidal behavior suggested a greater incidence of these events for paroxetine than for placebo (4.4% versus 2.1%); however, this difference was not statistically significant (odds ratio, 2.15, 95% Confidence Interval 0.45, 10.33; p = 0.502). CONCLUSIONS: No statistically significant differences were observed for paroxetine compared with placebo on the two prospectively defined primary efficacy variables. Paroxetine at 20-40 mg/day administered over a period of up to 12 weeks was generally well tolerated.
Journal of Child & Adolescent Psychopharmacology, 16(1-2) : 59-75
- Year: 2006
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
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
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Stage: Disorder established (diagnosed disorder)
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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