Disorders - Depressive Disorders
Jureidini, J. N., Doecke, C. J., Mansfield, P. R., Haby, M. M., Menkes, D. B., Tonkin, A. L.
How safe and effective are antidepressants in children and adolescents? The authors of this review have found disturbing shortcomings in the methods and reporting of trials of newer antidepressants in this patient group.
British Medical Journal, 328(7444) : 879-883
- Year: 2004
- 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)
DeCuyper, S., Timbremont, B., Braet, C., DeBacker, V., Wullaert, T.
Although studies on sub-threshold depression in childhood and adolescence have demonstrated an at risk profile that merits further attention, only few investigators examined the impact of therapy with these children. In this study, twenty elementary schoolchildren (aged 10-12) with moderate depressive symptoms were randomly assigned to an eighteen-session cognitive-behavioural treatment programme or to a waiting list (WL) control group (= Study 1). The key components of the programme 'Taking Action' used in the study were: affective education, problem-solving, cognitive restructuring and engaging in enjoyable activities. Child self-reports and parent reports were used to evaluate the outcome. Paired t-tests comparing the 4-months follow-up results with baseline measurements, revealed a significant improvement on the Children Depression Inventory and on the Self-Perception Profile for Children, but only in the treatment group. Afterwards, the WL control group was treated as well. All children were followed in a long-term follow-up study (= Study 2). Analyses at the 12 month stage of the follow-up study showed a further improvement of the scores on the Self-Perception Profile. Moreover, a significant decrease was found on the Children Depression Inventory, the State-Trait Anxiety Inventory and the Child Behaviour Checklist parent measure. It was concluded that the protocol is suitable for European children. The most remarkable findings in this pilot study are discussed.
European Child & Adolescent Psychiatry., 13(2) : 105-114
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Emslie, Graham J., Heiligenstein, John H., Hoog, Sharon L., Wagner, Karen Dineen, Findling, Robert L., McCracken, James T., Nilsson, Mary E., Jacobson, Jennie G.
OBJECTIVE: To compare fluoxetine 20 to 60 mg/day with placebo for prevention of relapse of major depressive disorder in children and adolescents who had achieved Children's Depression Rating Scale, Revised scores of < or =28 during treatment with fluoxetine 20 to 60 mg. METHOD: In this 32-week relapse-prevention phase of a double-blind, multicenter, placebo-controlled 51-week study, 20 patients continued to receive their fixed dose of fluoxetine (F/F group), while 20 similar patients were switched to placebo (F/P group). Definition of relapse for the primary analysis was a Children's Depression Rating Scale, Revised score of >40 with a 2-week history of clinical deterioration or relapse in the opinion of the physician. Adverse events were compared between treatment groups to assess discontinuation-emergent adverse events. RESULTS: Mean time to relapse was longer in the F/F recipients than in the F/P recipients (p=.046). Relapse occurred in an estimated 34% in the F/F cohort and 60% in the F/P cohort. Incidence of adverse events and tolerability were similar in the F/F and F/P groups, suggesting that fluoxetine is not associated with significant discontinuation events. CONCLUSIONS: Fluoxetine 20 to 60 mg/day was well tolerated and can significantly delay relapse of major depressive disorder symptoms in children and adolescents.
Journal of the American Academy of Child & Adolescent Psychiatry, 43(11) : 1397-405
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
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Stage: Relapse prevention
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Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Courtney, Darren B.
OBJECTIVE: This review critiques published randomized placebo-controlled trials pertaining to the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) and venlafaxine in the treatment of major depressive disorder in children and adolescents. METHOD: Medline was searched for articles meeting defined inclusion criteria. The following key terms were used: depressive disorders, antidepressive agents, fluoxetine, paroxetine, sertraline, citalopram, fluvoxamine, venlafaxine, child, and adolescent. RESULTS: Six articles met inclusion criteria. Only 2 studies claim efficacy by significant results in primary outcomes; both have since been contested in further analysis. Not one study adequately examines safety, particularly with respect to whether a link exists between antidepressant use and induction of suicidal ideation or attempts. CONCLUSION: Published studies on SSRI or venlafaxine use in children and adolescents are inconclusive with respect to safety and efficacy, owing to inappropriate claims of efficacy, lack of improvement in global functioning scores, nonstandardized data collection regarding adverse effects, exclusion of suicidal subjects in the recruitment process, grouping of children and adolescents together, small sample sizes, conflict of interest posed by pharmaceutical company sponsorship, and publishing bias. Future investigators should consider these factors when developing study designs. [References: 24]
Canadian Journal of Psychiatry, 49(8) : 557-63
- Year: 2004
- Problem: Depressive Disorders
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Cohen, David, Gerardin, Priscille, Mazet, Philippe, Purper-Ouakil, Diane, Flament, Martine F.
Antidepressant agents are widely prescribed for adolescents, although specific data regarding their efficacy in this age range are limited. The aims of the present article are to review research findings regarding the use of antidepressant drugs for adolescent depression and to discuss the main results in light of our clinical experience. Only 13 controlled trials on the use of antidepressant drugs for adolescent major depression are available in the literature. Six studies evaluated the efficacy of tricyclic antidepressants, yet they only included 196 adolescents altogether. Seven studies, including a total of 1,403 patients, evaluated the efficacy of three specific serotonin reuptake inhibitors: fluoxetine, paroxetine, and sertraline. Based on published data, serotonin reuptake inhibitors appear to be the first-line psychopharmacologic treatment for adolescent depression, as three compounds (fluoxetine, paroxetine, and sertraline) appeared to be effective in this indication. Conversely, all published studies failed to demonstrate that the tricyclic antidepressants were superior to placebo. Several questions remain open and are discussed: How should we use available scientific data in clinical practice? Are there nonspecific factors implicated in treatment response? Is there a serotonin hypothesis for juvenile depression? What are the priorities for future research? [References: 75]
Journal of Child & Adolescent Psychopharmacology, 14(1) : 19-31
- Year: 2004
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Antidepressants (any)
Compton, Scott N., March, John S., Brent, David, Albano, Anne Marie, Weersing, Robin, Curry, John
OBJECTIVE: To review the literature on the cognitive-behavioral treatment of children and adolescents with anxiety and depressive disorders within the conceptual framework of evidence-based medicine. METHOD: The psychiatric and psychological literature was systematically searched for controlled trials applying cognitive-behavioral treatment to pediatric anxiety and depressive disorders. RESULTS: For both anxiety and depression, substantial evidence supports the efficacy of problem-specific cognitive-behavioral interventions. Comparisons with wait-list, inactive control, and active control conditions suggest medium to large effects for symptom reduction in primary outcome domains. CONCLUSIONS: From an evidence-based perspective, cognitive-behavioral therapy is currently the treatment of choice for anxiety and depressive disorders in children and adolescents. Future research in this area will need to focus on comparing cognitive-behavioral psychotherapy with other treatments, component analyses, and the application of exportable protocol-driven treatments to divergent settings and patient populations. [References: 80]
Journal of the American Academy of Child & Adolescent Psychiatry, 43(8) : 930-59
- Year: 2004
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Hritzak, K., Culhane, N. S.
Journal of Family Practice., 53(1) : 11-12
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Jane-Llopis, Eva, Hosman, Clemens, Jenkins, Rachel, Anderson, Peter
BACKGROUND: Worldwide, 340 million people are affected by depression, with high comorbid, social and economic costs. AIMS: To identify potential predictors of effect in prevention programmes. METHOD: A meta-analysis was made of 69 programmes to reduce depression or depressive symptoms. RESULTS: The weighted mean effect size of 0.22 was effective for different age groups and different levels of risk, and in reducing risk factors and depressive or psychiatric symptoms. Programmes with larger effect sizes were multi-component, included competence techniques, had more than eight sessions, had sessions 60-90 min long, had a high quality of research design and were delivered by a health care provider in targeted programmes. Older people benefited from social support, whereas behavioural methods were detrimental. CONCLUSIONS: An 11% improvement in depressive symptoms can be achieved through prevention programmes. Single trial evaluations should ensure high quality of the research design and detailed reporting of results and potential predictors. [References: 84]
British Journal of Psychiatry, 183 : 384-97
- Year: 2003
- Problem: Depressive Disorders
- Type: Systematic reviews
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Stage: Universal prevention
, At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., Zaragoza, C., Fink, A.
Objective: To pilot-test a school mental health program for Latino immigrant students who have been exposed to community violence. Method: In this quasi-experimental study conducted from January through June 2000, 198 students in third through eighth grade with trauma-related depression and/or posttraumatic stress disorder symptoms were compared after receiving an intervention or being on a waitlist. The intervention consisted of a manual-based, eight-session, group cognitive-behavioral therapy (CBT) delivered in Spanish by bilingual, bicultural school social workers. Parents and teachers were eligible to receive psychoeducation and support services. Results: Students in the intervention group (n = 152) had significantly greater improvement in posttraumatic stress disorder and depressive symptoms compared with those on the waitlist (n = 47) at 3-month follow-up, adjusting for relevant covariates. Conclusions: A collaborative research team of school clinicians, educators, and researchers developed this trauma-focused CBT program for Latino immigrant students and their families. This pilot test demonstrated that this program for traumatized youths, designed for delivery on school campuses by school clinicians, can be implemented and evaluated in the school setting and is associated with a modest decline in trauma-related mental health problems.
Journal of the American Academy of Child & Adolescent Psychiatry, 42(3) : 311-8
- Year: 2003
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Milin, Robert, Walker, Selena, Chow, Joy
OBJECTIVE: Treating adolescents with depression remains a major clinical and public health challenge. Because of the serious morbidity and mortality associated with adolescent major depressive disorder (MDD), there is a need to review the published literature on treatment efficacy to establish effective treatment choices for these adolescents. METHOD: We reviewed the recent literature on the treatment of MDD in adolescents using the Medline and PsycINFO computerized databases. RESULTS: Results of open studies of MDD treatment in adolescents suggested therapeutic efficacy; however, later, better-controlled studies are more difficult to interpret, owing to the high rate of improvement with placebo. Currently, there is limited evidence of robust, effective therapeutic interventions in children and in adolescent depressive disorders. CONCLUSIONS: Despite limitations, current findings from studies investigating selective serotonin reuptake inhibitors (SSRIs), cognitive-behavioural therapy, and interpersonal therapy generally support these treatments as safe and effective for adolescent MDD. Still, further investigations into these treatments for adolescent depression are warranted. [References: 85]
Canadian Journal of Psychiatry, 48(9) : 600-6
- Year: 2003
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Lock, S, Barrett, P.M
The present paper presents the results of a longitudinal study evaluating the effects of a universal school-based intervention for child anxiety at two developmental stages. The study involved a cohort of 733 children enrolled in grade 6 (n = 336, 45.6%) aged between 9 and 10 years, and grade 9 (n = 401, 54.4%) aged between 14 and 16 years. Participants were allocated to either a school-based cognitive-behavioural intervention or to a monitoring group, and completed standardised measures of anxiety, depression and coping style. Young people identified as "at risk" of an anxiety disorder were assessed for a clinical diagnosis with a structured diagnostic interview. Findings showed universal intervention as potentially successful in reducing symptoms of anxiety and increasing coping skills in children. Primary school children reported the greatest changes in anxiety symptoms, suggesting earlier preventive intervention was potentially more advantageous than later intervention. Developmental differences in anxiety, depression and coping strategies are discussed in addition to the implications and limitations of this study and directions for future research.
Behaviour Change, 20(4) : 183-199
- Year: 2003
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Lowry-Webster, Hayley M., Barrett, Paula M., Lock, Sally
In 2001 we evaluated a universal prevention trial of anxiety during childhood, and also examined the effects of the program on levels of depression. Participants were 594 children aged 10-13 years from seven schools in Brisbane, Australia, who were randomly assigned to an intervention or control group on a school-by-school basis. The intervention was based on the group CBT program FRIENDS (Barrett, Lowry-Webster & Holmes, 1999a, 1999b, 1999c). Results were examined universally (for all children) and for children who scored above the clinical cut-off for anxiety at pre-test. At 12-month follow-up, intervention gains were maintained, as measured by self-reports and diagnostic interviews. Eighty-five per cent of children in the intervention group who were scoring above the clinical cut-off for anxiety and depression were diagnosis free in the intervention condition, compared to only 31.2% of children in the control group. Implications of these findings are examined, alongside limitations and directions for future research. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (journal abstract).
Behaviour Change, 20(1) : 25-43
- Year: 2003
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)