Disorders - Depressive Disorders
Emslie, G. J., Rush, A. J., Weinberg, W. A.
Evidence-Based Medicine, 3(4) : 105
- Year: 1998
- Problem: Depressive Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Harrington, R., Whittaker, J., Shoebridge, P., Campbell, F.
Objective: To determine whether cognitive behaviour therapy is an effective treatment for childhood and adolescent depressive disorder. Design: Systematic review of six randomised trials comparing the efficacy of cognitive behaviour therapy with inactive interventions in subjects aged 8 to 19 years with depressive disorder. Main outcome measure: Remission from depressive disorder. Results: The rate of remission from depressive disorder was higher in the therapy group (129/208; 62%) than in the comparison group (61/168; 36%). The pooled odds ratio was 3.2 (95% confidence interval 1.9 to 5.2), suggesting a significant benefit of active treatment. Most studies, however, were based on relatively mild cases of depression and were of only moderate quality. Conclusions: Cognitive behaviour therapy may be of benefit for depressive disorder of moderate severity in children and adolescents. It cannot, however, yet be recommended for severe depression. Definitive large trials will be required to determine whether the results of this systematic review are reliable.
British Medical Journal, 316(7144) : 1559-1563
- Year: 1998
- Problem: Depressive Disorders
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Klein, R. G., Mannuzza, S., Koplewicz, H. S., Tancer, N. K., Shah, M., Liang, V., Davies, M.
The study was designed to test the efficacy of desipramine in adolescents with major depression (MDD). In addition, we assessed the presence of atypical features of MDD, consisting of mood reactivity and two of four associated features (rejection sensitivity, hyperphagia, hypersomnia, and leaden paralysis). Patients were randomized to desipramine (DMI) or placebo for 6 weeks, provided they failed to improve (e.g., meeting MDD criteria and a Hamilton Depression Scale score [less-than or equal to]18) after 2 weeks on single blind placebo. Of 94 adolescents (ages 13-18) who were diagnosed as having MDD, 64 entered the study and 62 received placebo for 2 weeks. Of these, 45 were randomized to DMI or placebo. Completer analyses did not reveal significant improvement for the active treatment compared to the placebo. A large proportion of adolescents responded to placebo (50%), suggesting the need for very large samples to detect differential treatment efficacy, should it exist. A relatively high rate of atypical depression was observed (47% in the 64 patients entered). In view of the demonstrated specificity of monoamine oxidase inhibitor efficacy in adults with atypical features of MDD, this clinical subtype may have relevance to future investigation of therapeutic interventions in adolescent MDD.
Depression & Anxiety, 7(1) : 15-31
- Year: 1998
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Tricyclic antidepressants
Mandoki, M. W., Tapia, M. R., Tapia, M. A., Sumner, G. S., Parker, J. L.
Major depression is commonly found in the child and adolescent population. Venlafaxine, a new antidepressant, has been used successfully in adults; however, its use in children and adolescents has been very limited. This study evaluated the efficacy and side effect profile of venlafaxine in the treatment of depression in children and adolescents. In a double-blind, placebo-controlled, 6-week study, 33 subjects between the ages of 8 and 17, who met DSM-IV criteria for major depression, were treated with either venlafaxine and therapy or placebo and therapy. Patient progress data were obtained by weekly rating assessments. Data on side effects were also obtained weekly. The statistical analysis indicated a significant improvement over time, but it could not be attributed to venlafaxine drug therapy. These findings are consistent with other studies where the efficacy of antidepressants in the treatment of major depression in this age population remains unproven. Low dosage and short length of treatment may account for the lack of efficacy. The findings did, however, suggest a low side-effect profile. Further studies are recommended to assess efficacy and to corroborate its safety in children and adolescents.
Psychopharmacology Bulletin, 33(1) : 149-54
- Year: 1997
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Emslie, Graham J., Rush, John, Weinberg, Warren A., Kowatch, Robert A., Hughes, Carroll W., Carmody, Tom, Rintelmann, Jeanne
Evaluated the efficacy, safety, and tolerability of fluoxetine treatment for children with nonpsychotic major depressive disorders (NMDD). 96 outpatients (aged 7-17 yrs) meeting Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for NMDD participated in a randomized, double-blind, placebo-controlled study. 48 of the patients were randomized to fluoxetine treatment and the other 48 received placebo. The 2 major outcome measures were the Clinical Global Impressions (CGI) scale and the Children's Depression Rating Scale--Revised (CDRS--R) and were administered weekly throughout the 8-wk study. 27 Ss receiving fluoxetine and 16 receiving placebo were rated as "much" or "very much" improved according to the CGI. The CDRS--R scores were significantly lower for the fluoxetine group at week 5. Overall, results suggest that fluoxetine was significantly more effective than placebo in the acute phase treatment of NMDD, but complete remission was rare. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Archives of General Psychiatry, 54(11) : 1031-1037
- Year: 1997
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Beardslee, W. R., Versage, E. M., Wright, E. J., Salt, P., Rothberg, P. C., Drezner, K., Gladstone, T. R.
Thirty-seven families who had a child between the ages of 8 and 15 (mean age = 12.0 years) and had at least one parent, who had experienced a recent episode of affective disorder were assigned randomly to one of two psychoeducational interventions. The interventions (clinician-facilitated or lecture-group discussion) were designed to prevent childhood depression and related problems through decreasing the impact of related risk factors and encouraging resiliency-promoting behaviors and attitudes. They were similar in content but differed in the level of the children's involvement and the degree to which the families' individual life experiences were linked to the educational material. Assessments included standard diagnostic and social functioning instruments and interviews designed specifically for this project to assess behavior and attitude change. Each parent and child was individually assessed by separate assessors who were blind to information about the other family members. Parent participants in both groups reported being satisfied with the intervention. Clinician group participants reported a significantly larger number of overall changes, as well as higher levels of change regarding communications about the illness with their children and increased understanding by the children of their illness. Significantly more children in the clinician group also reported they gained a better understanding of parental affective illness as a result of their participation in the project.
Development & Psychopathology, 9(1) : 109-30
- Year: 1997
- 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)
, Psychoeducation
Beardslee, William R., Wright, Ellen J., Salt, Patricia, Drezner, Karen
Examined long-term effects of 2 forms of preventive intervention designed to increase families' understanding of parental affective disorder and to prevent depression in children. 36 families who had a nondepressed child between ages 8 and 15 yrs and a parent who had experienced affective disorder were enrolled and randomly assigned to either a clinician-facilitated intervention or a lecture discussion group. Each parent and child were assessed prior to randomization, after intervention, and approximately 1.5 yrs after enrollment. Assessments included standard diagnostic interviews, measures of child and family functioning, and interviews about experience of parental affective disorder and intervention effects. Children in the clinician-facilitated group reported greater understanding of parental affective disorder, as rated by self-report, rater-generated scales, and parent report, and had better adaptive functioning after intervention. Parents in the clinician-facilitated intervention group reported significantly more change. Findings from both interventions support the value of a future-oriented resiliency-based approach. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Journal of the American Academy of Child & Adolescent Psychiatry, 36(2) : 196-204
- Year: 1997
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Psychoeducation
Brent, David A., Holder, Diane, Kolko, David, Birmaher, Boris, Baugher, Marianne, Roth, Claudia, Iyengar, Satish, Johnson, Barbara A.
Compared the efficacy of individual cognitive behavior therapy (CBT), systemic behavior family therapy (SBFT), and individual nondirective supportive treatment (NST) among 107 adolescents with Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) major depressive disorder. Ss were randomized to 1 of the 3 treatments; 37 Ss received CBT, 35 Ss received SBFT, and 35 Ss received NST. Outcome assessment included depression symptoms as measured by the Beck Depression Inventory, suicidality, functional impairment, and parent-rated treatment expectancy and credibility. CBT was more effective than SBFT or NST with respect to clinical recovery, rate of symptomatic improvement, and parent-rated treatment credibility. However, no group differences were seen for effect on suicidality or on functional status. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Archives of General Psychiatry, 54(9) : 877-885
- Year: 1997
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy, Supportive therapy
Weisz, J. R., Thurber, C. A., Proffitt, V. D., Sweeney, L., LeGagnoux, G. L.
Elementary school children with mild-to-moderate depressive symptoms were randomly assigned to a control group or an 8-session Primary and Secondary Control Enhancement Training program. The program focused on (a) primary control (changing objective conditions to fit one's wishes; e.g., through activity selection and goal attainment) and (b) secondary control (changing oneself to buffer the impact of objective conditions; e.g., altering depressogenic thinking, practicing mood-enhancing cognitions). At immediate posttreatment and 9-month follow-up, the treatment group showed greater reductions than the control group in depressive symptomatology on the Children's Depression Inventory and the Revised Children's Depression Rating Scale, and treated children, more than controls, shifted' from above to within the normal range on both measures. Future research is needed to test treatment effects with severely depressed youths.
Journal of Consulting & Clinical Psychology., 65(4) : 703-707
- Year: 1997
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Sallee, F. R., Vrindavanam, N. S., Deas-Nesmith, D., Carson, S. W., Sethuraman, G.
OBJECTIVE: Major depressive disorder in adolescents is characterized as treatment resistant, but a previous open-label trial of pulse intravenous clomipramine demonstrated rapid relief of depressive symptoms. In the present study a single intravenous dose of clomipramine (200 mg) was compared with saline placebo in a randomized controlled trial for depressed adolescents. The hypothesis was that adolescents who were treated with pulse clomipramine would exhibit lower scores on the Hamilton Depression Rating Scale at endpoint than would adolescents who received saline and that clomipramine would be superior to saline in terms of antidepressant response. METHOD: Sixteen nonsuicidal outpatient adolescents (mean age = 16.2 years, SD = 1.0) who met the DSM-III-R criteria for major depression (score on 21-item Hamilton scale, > or = 18) were randomly assigned to receive either clomipramine (200 mg i.v., N = 8) or saline (N = 8). Assessments of depression severity were completed 36 hours and 6 days thereafter. RESULTS: The adolescents who received pulse clomipramine treatment demonstrated significant decreases in Hamilton depression scores from baseline at 6 days but not at 36 hours. A similar decrease from baseline was found in Clinical Global Impression severity at 6 days but not 36 hours. Seven of the clomipramine-treated patients and three of the saline-treated patients had drops of 50% or more from baseline in Hamilton depression score. CONCLUSIONS: Pulse clomipramine (200 mg i.v.) is associated with dramatic reduction in depressive symptoms at day 6 after infusion, which is significantly different from the effect of placebo.
American Journal of Psychiatry, 154(5) : 668-73
- Year: 1997
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Tricyclic antidepressants
Vostanis, Panos, Feehan, Catherine, Grattan, Eleanor, Bickerton, Wai-Ling
Nine-month outcome data of a randomized controlled outpatient trial of cognitive-behavioral treatment (CBT) for children and adolescents with depression are presented. CBT was compared with a nonfocussed intervention in 56 Ss (aged 8-17 yrs). At 9 mo after the termination of the trial, 21 children (37.5%) fulfilled criteria for a psychiatric disorder, out of whom 15 (26.8%) had a depressive illness. However, 25 Ss (45%) reported depressive symptoms of significant severity to suggest a depressive episode during the previous 9 mo. Both treatment groups maintained a significant improvement on all psychosocial measures since the post-treatment assessment. No significant treatment effect was established. Low self-esteem at the time of referral, predicted presence of psychiatric disorder, and child-reported scores of depressive symptoms and low self-esteem at follow-up. The research and clinical implications for the treatment of depressive disorders in young life are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Journal of Affective Disorders, 40(1-2) : 105-116
- Year: 1996
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Vostanis, Panos, Feehan, Catherine, Grattan, Eleanor, Bickerton, Wai-Ling
Cognitive-behavioral treatment (CBT) appears to have considerable value in the treatment of childhood depression. Its key components are self-monitoring, social problem-solving and cognitive restructuring. Such a treatment program was compared with a non-focused control intervention (NFI) in 57 outpatient children and adolescents (8-17 yrs old) with depression. Both groups improved significantly on depressive and anxiety symptoms, self-esteem and social functioning, with the majority of children (87 percent of CBT subjects and 75 percent of controls) no longer being clinically depressed. Non-specific psychotherapeutic elements such as empathy, sympathetic listening, reassurance, reinforcement and indirect ways of achieving self-understanding and problem-solving may be involved in the recovery. In outpatient settings, it is recommend that social problem-solving and cognitive restructuring be introduced during the first 2-3 sessions, which may help the young person gain self-control relatively early and engage more with the treatment. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Clinical Child Psychology & Psychiatry, 1(2) : 199-212
- Year: 1996
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)