Disorders - Depressive Disorders
Ambrosini, P. J.
OBJECTIVE: The review examined the historical progression and current status of pharmacotherapy of child and adolescent major affective disorder. METHODS: A MEDLINE search was used to identify double-blind, placebo-controlled studies of child and adolescent major depression. Only studies that used reliable diagnostic and recovery parameters were included. RESULTS: Few well-designed studies have compared placebo and tricyclic antidepressants in the treatment of major depressive disorder in children and adolescents. However, results consistently suggest that tricyclic antidepressants are not efficacious. Early results of double-blind placebo-controlled trials with fluoxetine and paroxetine have shown a significant drug effect. However, the results are inconsistent, which could reflect the ways that response to medication is defined, the ways that rating scales measure recovery, and uncertainties of dosing strategies with second-generation antidepressants. Hypothesized reasons for the unique response pattern in youths include the changing hormonal status of children, the differential maturation of the noradrenergic versus serotonergic neurotransmitter systems, and the possibility that a large proportion of depressed youths are in the early stages of bipolar disorder, which is not effectively treated by these medications. CONCLUSIONS: Tricyclic antidepressants are not superior to placebo for the treatment of child and adolescent major depressive disorder. Although two of three trials of second-generation antidepressants in this age group have had negative results, data suggest that these drugs may be more promising. It is too early in our investigation to know whether these agents will be effective in treating major depressive disorder in children and adolescents. [References: 48]
Psychiatric Services, 51(5) : 627-33
- Year: 2000
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Antidepressants (any)
Maneeton, N., Srisurapanont, M.
The tricyclic antidepressants (TCAs) are effective for the treatment of adult depression. However, their efficacy of these in the treatment of children and adolescents with depression is equivocal. Therefore, it is necessary to determine the efficacy and acceptability of TCAs in the treatment of depressive disorders in children and adolescents. The databases of MEDLINE (from 1966 to October 1999) and Controlled Clinical Trials Registered (from 1980 to October 1999) were searched for randomized-controlled trials relevant to the use of TCAs for treating depressed children and adolescents. The reviewers also examined the reference lists of identified papers and that of a previous meta-analysis. In each trial, both nonresponse rates and dropout rates were taken into account and extracted on an intention-to-treat basis. The nonresponse-rate and dropout-rate odd ratios (ORs) with 95 per cent confidence intervals (95% CIs) of each trial and the pooled non-response-rate and dropout-rate ORs (95% CIs) of all trials were computed. Nine trials included in this meta-analysis were 2 amitriptyline, 3 desipramine, 2 imipramine, and 2 nortriptyline studies. By using a fixed-effect model, the pooled nonresponse-rate OR (95% CI) and the pooled dropout rate OR (95% CI) of antidepressant-treated group were 0.92 (0.57 to 1.47) and 2.14 (1.12 to 4.09), respectively. In summary, the evidence so far does not support that TCAs are more effective or more acceptable than placebo in the treatment of depressive disorders in children and adolescents. However, the studies of selective serotonin reuptake inhibitors and newer antidepressants for the treatment of these disorders should be further investigated.
Journal of the Medical Association of Thailand, 83(11) : 1367-74
- Year: 2000
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Tricyclic antidepressants
Deas, Deborah, Randall, Carrie L., Roberts, James S., Anton, Raymond F.
In order to preliminarily evaluate the efficacy, safety and tolerability of the serotonin reuptake inhibitor, sertraline, in the treatment of adolescents with a primary depressive disorder and a comorbid alcohol use disorder, a 12-wk, double-blind, placebo-controlled trial of sertraline plus cognitive behavior group therapy was conducted. Ss were 10 outpatient treatment-seeking adolescents. Baseline assessment included the K-SADS, HAM-D, SCID, and the Time-Line Follow-Back. The HAM-D and the Time-Line Follow-Back were performed weekly thereafter. Both groups showed a significant reduction in depression scores with an average reduction between baseline and endpoint HAM-D score of -9.8, although there were no significant group differences. There was an overall reduction in Percent Days Drinking (PDD) and in Drinks Per Drinking Day (DDD), however, there were no group differences. Depression responders tended to have higher baseline PDD than non-responders and change in HAM-D scores tended to correlate with change in PDD. Our data support that sertraline is safe and well tolerated in the treatment of adolescents with depression and alcohol dependence. Small sample size and cognitive behavior group therapy given to all Ss may limit the lack of group differences. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Human Psychopharmacology: Clinical & Experimental, 15(6) : 461-469
- Year: 2000
- 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)
Gillham, Jane E., Reivich, Karen J.
Shows the effect of a program to prevent depression symptoms and episodes on explanatory style. Long-term follow-up results of a school-based program designed to prevent depressive symptoms in 1995; Consequences of optimistic versus pessimistic explanatory styles.
Psychological Science, 10(5) : 461
- Year: 1999
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Clarke, G. N., Rohde, P., Lewinsohn, P. M., Hops, H., Seeley, J. R.
OBJECTIVE: This trial examined the effects of both acute and maintenance cognitive-behavioral therapy (CBT) for depressed adolescents. METHOD: Adolescents with major depression or dysthymia (N = 123) were randomly assigned to 1 of 3 eight-week acute conditions: adolescent group CBT (16 two-hour sessions); adolescent group CBT with a separate parent group; or waitlist control. Subsequently, participants completing the acute CBT groups were randomly reassigned to 1 of 3 conditions for the 24-month follow-up period: assessments every 4 months with booster sessions; assessments only every 4 months; or assessments only every 12 months. RESULTS: Acute CBT groups yielded higher depression recovery rates (66.7%) than the waitlist (48.1%), and greater reduction in self-reported depression. Outcomes for the adolescent-only and adolescent + parent conditions were not significantly different. Rates of recurrence during the 2-year follow-up were lower than found with treated adult depression. The booster sessions did not reduce the rate of recurrence in the follow-up period but appeared to accelerate recovery among participants who were still depressed at the end of the acute phase. CONCLUSIONS: The findings, which replicate and expand upon a previous study, support the growing evidence that CBT is an effective intervention for adolescent depression.
Journal of the American Academy of Child & Adolescent Psychiatry, 38(3) : 272-9
- Year: 1999
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Avci, A., Diler, R. S., Kibar, M., Sezgin, F.
Purpose: In a prospective, randomized double-blind 5-week study, it was aimed to compare the efficacy of moclobemide with placebo in the treatment of young adolescents with major depressive disorder. Methods: 9 girls and 11 boys, range 9-15 years, who fulfilled the criteria for major depressive disorder according to DSM-4 were evaluated at an outpatient child and adolescent psychiatry clinic, and included in a double-blind study, comparing moclobemide and placebo during 5 weeks of treatment. SPECT was used in evaluation. Children Depression Inventory (CDI), State and Trait Anxiety Inventory for Children (STAIC-S, STAIC-T) were given to the patients, and Children Depression Inventory for Parents (CDI-P) were given to the parents at the beginning and at the end of the study. Clinical Global Impression (CGI) (Global Recovery, Severity and Adverse Effects) were recorded by the same child psychiatrists weekly. Adverse Effects Forms were self-recorded by the children weekly. Results: At the end of the study the average score of Adverse Effects show statistically no difference. Global recovery scores showed a statistically significant difference in favour of moclobemide group. There were reductions in anxiety and depression scores in both groups at the end of study. In SPECT findings, regional cerebral blood flow increased significantly at anterofrontal and left prefrontal regions at end of the study in moclobemide group. There were significant increases in right temporo-occipital and right temporal regions in both study groups in favour of moclobemide group. Conclusion: Moclobemide was considered to be effective, tolerable and safe in young adolescents.
Annals of Medical Sciences, 8(1) : 31-40
- Year: 1999
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Monoamine oxidase inhibitors (MAOIs) & ARIMAs
Seligman, Me, Schulman, P., DeRubeis, R. J, Hollon, S. D.
A brief and inexpensive cognitive - behavioral prevention program was given to university students at risk for depression. At risk was defined as being in the most pessimistic quarter of explanatory style. 231 students were randomized into either an 8-wk prevention workshop that met in groups of 10, once per week for 2 hr, or into an assessment-only control group. Ss were followed for 3 yrs and the authors report the preventive effects of the workshop on depression and anxiety. First, the workshop group had significantly fewer episodes of generalized anxiety disorder than the control group and showed a trend toward fewer major depressive episodes. The workshop group had significantly fewer moderate depressive episodes but no fewer severe depressive episodes. Second, the workshop group had significantly fewer depressive symptoms and anxiety symptoms than the control group, as measured by self-report but not by clinicians' ratings. Third, the workshop group had significantly greater improvements in explanatory style, hopelessness, and dysfunctional attitudes than the control group and these were significant mediators of depressive symptom prevention in the workshop group. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Prevention & Treatment, 2(Art 8) :
- Year: 1999
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Mufson, L., Weissman, M. M., Moreau, D., Garfinkel, R.
BACKGROUND: Psychotherapy is widely used for depressed adolescents, but evidence supporting its efficacy is sparse. METHODS: In a controlled, 12-week, clinical trial of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), 48 clinic-referred adolescents (aged 12-18 years) who met the criteria for DSM-III-R major depressive disorder were randomly assigned to either weekly IPT-A or clinical monitoring. Patients were seen biweekly by a "blind" independent evaluator to assess their symptoms, social functioning, and social problem-solving skills. Thirty-two of the 48 patients completed the protocol (21 IPT-A-assigned patients and 11 patients in the control group). RESULTS: Patients who received IPT-A reported a notably greater decrease in depressive symptoms and greater improvement in overall social functioning, functioning with friends, and specific problem-solving skills. In the intent-to-treat sample, 18 (75%) of 24 patients who received IPT-A compared with 11 patients (46%) in the control condition met recovery criterion (Hamilton Rating Scale for Depression score < or =6) at week 12. CONCLUSIONS: These preliminary findings support the feasibility, acceptability, and efficacy of 12 weeks of IPT-A in acutely depressed adolescents in reducing depressive symptoms and improving social functioning and interpersonal problem-solving skills. Because it is a small sample consisting largely of Latino, low socioeconomic status adolescents, further studies must be conducted with other adolescent populations to confirm the generalizability of the findings.
Archives of General Psychiatry, 56(6) : 573-9
- Year: 1999
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Interpersonal therapy (IPT)
Reinecke, Mark A., Ryan, Nancy E., DuBois, David L.
Critically reviews the literature on cognitive-behavioral therapy with depressed and dysphoric adolescents. A meta-analysis was conducted to assess the effectiveness of these approaches and the stability of therapeutic gains. 14 posttreatment-control comparisons and 10 followup-control comparisons resulted from 6 studies containing 217 Ss (children, adolescents, and adults). Results suggest the short- and long-term effectiveness of cognitive-behavioral approaches for treating depressive symptoms with this population. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Journal of the American Academy of Child & Adolescent Psychiatry, 37(1) : 26-34
- Year: 1998
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Vostanis, P., Feehan, C., Grattan, E.
Fifty-four children and adolescents (age 8-17) were assessed two years after a clinical intervention trial of cognitive-behavioural vs. non-focused treatment for depression. Eleven (20.4%) subjects fulfilled criteria for depression, while 21 (38.9%) reported significant depressive symptoms during the previous year. Seventeen young people (31.5%) had a psychiatric disorder (including depression). Overall, the sample maintained the improvement since the termination of treatment, without detecting specific treatment effects. Presence of depression at two-year follow-up was best predicted by self- esteem ratings before and after treatment, and co-morbidity at post- treatment. Depression in young life carries a high risk of recurrence, despite initial remission. Continuation or preventative treatment for young people at risk of relapse needs development and evaluation.
European Child & Adolescent Psychiatry., 7(1) : 12-18
- Year: 1998
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Birmaher, Boris, Waterman, G., Ryan, Neal D., Perel, James, McNabb, Joanne, Balach, Lisa, Beaudry, Mary Beth, Nasr, Farida N., Karambelkar, Jagannath, Elterich, Gertrude, Quintana, Humberto, Williamson, Douglas E., Rao, Uma
Assessed the response to a serotonergic/noradrenergic tricyclic antidepressant, amitriptyline (AMI), in a group of adolescents with treatment-resistant major depressive disorder (MDD). 27 depressed adolescents admitted to a state hospital underwent a 10-wk randomized, controlled trial with a flexible dose of AMI or placebo. There were no differences between patients taking AMI (13 Ss) and placebo (14 Ss). Both treatment groups showed approximately 70-80% improvement on the clinical outcome measurements, and 65-70% showed functional improvement. At the end of the protocol, 30% of patients still fulfilled criteria for MDD and had impaired functioning. Patients taking AMI experienced significantly more dry mouth and tachycardia. The final AMI dose was 173.1 mg/day 56.3 mg/day No significant differences were found between AMI and placebo, in part because of the high placebo response rate. Although both treatment groups showed substantial response, at the end of treatment a substantial proportion of patients still had MDD or subsyndromal symptoms of depression. This and other studies of tricyclic antidepressants question the use of this medication as 1st-line treatment for youths with MDD. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Journal of the American Academy of Child & Adolescent Psychiatry, 37(5) : 527-535
- Year: 1998
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Tricyclic antidepressants
Geller, Barbara, Cooper, Thomas B., Zimerman, Betsy, Frazier, Jeanne, Williams, Marlene, Heath, Janet, Warner, Kathy
Examined the hypothesis that lithium would be efficacious treatment for prepubertal major depressive disorder (PMDD) in children who also had family history (FH) predictors of future bipolar disorder (BP). A double-blind, placebo-controlled, and pharmacokinetically dosed study of lithium for PMDD with FH predictors of future BP was performed. Random assignment was stratified by FH of BP-I or mania vs loaded/multigenerational (L/M) FH of MDD without BP-I or mania. 17 Ss (aged 6-12 yrs) were randomized to active and 13 to placebo; 80% had FH of BP-I or mania (40% of parents had BP-I or mania); and 20% had FH of L/M MDD. Using both intent to treat with last observation carried forward and completer analyses, there were no significant differences on continuous or categorical measures between active and placebo groups. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Journal of Affective Disorders, 51(2) : 165-175
- Year: 1998
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Lithium