Conclusions

On the basis of available evidence, several conclusions regarding depression in adolescents and children can be drawn with some confidence. First, early-onset unipolar depression is often a chronic, recurring condition. It is associated with vulnerability for recurrent depression during adulthood, with impaired social, emotional, and academic functioning. It is a condition that places a burden on families and causes suffering for the child and his/her family. Second, a number of methodologically sound outcome studies have been completed during recent years. As a group, they suggest that CBT can be effective for treating major depression among adolescents. CBT appears to be more effective than no treatment, a wait-list control, or simple support. Although CBT has been found to be more effective than some other forms of psychotherapy (Brent et al., 1997), it has not been found to be as effective acutely as fluoxetine (TADS Team, 2004). Preliminary evidence indicates that, taking risk and benefit into account, the combination of CBT and an SSRI may offer the best chance of rapid clinical improvement and enhanced psychosocial functioning (TADS Team, 2004), and that CBT may be as effective as medication alone over 36 weeks of treatment. On the basis of research regarding course, phenomenology, and response to treatment, we suggest that early-onset major depression may usefully be conceptualized as a chronic disorder, and that it should be treated accordingly.

Looking forward, additional work is needed to make CBT, and other forms of empirically-supported treatment, more available, and to determine which components of the treatment mediate improvement. Although research to date has been fairly consistent in suggesting that CBT can be helpful in treating adolescents with MDD, it is not clear that CBT is uniquely helpful. Interpersonal psychotherapy also appears to be efficacious, although it has not yet been compared to or combined with medication. Work is also needed on the prevention of relapse among depressed children and adolescents, and on the treatment of adolescents who fail to respond to an initial treatment trial. Although we have learned a great deal about early-onset affective disorders during the past 20 years, our work is, in a true sense, only beginning. For these most challenging cases, a great deal of additional work remains to be done.

REFERENCES

Beck, A., Rush, A., Shaw, B., & Emery, G. (1979). Cognitive therapy of depression. New

York: Guilford Press. Bradley, S. (2000). Affect regulation and the development of psychopathology. New York: Guilford Press.

Brent, D. (1995). Risk factors for adolescent suicide and suicidal behavior: Mental and substance abuse disorders, family environmental factors, and life stress. Suicide and Life Threatening Behavior, 25, 52-63. Brent, D., Holder, D., Kolko, D., Birmaher, B., Baugher, M., Roth, C. et al. (1997). A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive treatments. Archives of General Psychiatry, 54, 877-885. Brent, D., & Poling, K. (1997). Cognitive therapy treatment manual for depressed and suicidal youth. University of Pittsburgh, unpublished manuscript Clarke, G., Rohde, P., Lewinsohn, P., Hops, H., & Seeley, J. (1999). Efficacy of acute group treatment and booster sessions. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 272-279. Curry, J., & Reinecke, M. (2003). Modular therapy for adolescents with major depression. In M. Reinecke, F. Dattilio, & A. Freeman (Eds.), Cognitive therapy with children and adolescents (2nd ed., pp. 95-127). New York: Guilford Press.

Curry, J., & Wells, K. (2005). Striving for effectiveness in the treatment ofadolescent depression: Cognitive behavior therapy for multisite community intervention. Cognitive and Behavioral Practice, 12, 177-185.

Emslie, G., Rush, A., Weinberg, W, Kowatch, R., Hughes, C., Carmody T., et al. (1997). A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Archives of General Psychiatry, 54, 1031-1037.

Essau, C., & Dobson, K. (1999). Epidemiology of depressive disorders. In C. Essau & F. Petermann (Eds.), Depressive disorders in children and adolescents: Epidemiology, course and treatment (pp. 69-103). Northvale, NJ: Aronson.

Gracious, B., Youngstrom, E., Findling, R., & Calabrese, J. (2002). Discriminative validity of a parent version of the Young Mania Rating Scale. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1350-1359.

Hammad, T., Laughren, T., & Racoosin, J. (2006). Suicidality in pediatric patients treated with antidepressant drugs. Archives of General Psychiatry, 63, 332-339.

Kaslow, N., Deering, C., & Racusin, G. (1994). Depressed children and their families. Clinical Psychology Review, 14, 39-59.

Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children— Present Episode and Lifetime Version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980-988.

Keller, M., McCullough, J., Klein, D., Arnow, B., Dunner, D., Gelenberg, A., et al. (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342, 1462-1470.

Kendler, K., Thornton, L., & Gardner, C. (2000). Stressful life events and previous episodes in the etiology of major depression in women: An evaluation of the "kindling" hypothesis. American Journal of Psychiatry, 157, 1243-1251.

Klein, D., Dougherty, L., & Olino, T. (2005). Toward guidelines for evidence-based assessment of depression in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34, 412-432.

Klein, J., Jacobs, R., & Reinecke, M. (2007). Cognitive-behavioral therapy for adolescent depression: A meta-analytic investigation of chagnes in effect size estimates. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1403-1413.

Kovacs, M., Obrosky, D., Gatsonis, C., & Richards, C. (1997). First-episode major depressive and dysthymic disorder in childhood: Clinical and sociodemo-graphic factors in recovery. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 777-784.

Lewinsohn, P., Clarke, G., Hops, H., & Andrews, J. (1990). Cognitive-behavioral treatment for depressed adolescents. Behavior Therapy, 21, 385-401.

Linehan,M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.

Poznanski, E., & Mokros, H. (1995). Children's Depression Rating Scale—Revised (CDRS-R). Los Angeles: Western Psychological Services.

Rao, U., Ryan, N., Birmaher, B., Dahl, R., Williamson, D., Kaufman, J., et al. (1995). Unipolar depression in adolescents: Clinical outcome in adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 566-578.

Reinecke, M., Ryan, N., & DuBois, D. (1998). Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: A review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 26-34.

Reinecke, M., & Simons, A. (2005). Vulnerability to depression among adolescents: Implications for cognitive-behavioral treatment. Cognitive and Behavioral Practice, 12, 166-176.

Reynolds, W (1987). Reynolds Adolescent Depression Scale manual. Odessa, FL: Psychological Assessment Resources.

Reynolds, W, & Mazza, J. (1998). Reliability and validity of the Reynolds Adolescent Depression Scale with young adolescents. Journal of School Psychology, 36, 295-312.

Rogers, G., Reinecke, M., & Curry, J. (2005). Case formulation in TADS CBT. Cognitive and Behavioral Practice, 12, 198-208.

Rotheram, M. (1987). Evaluation of imminent danger for suicide among youth. American Journal of Orthopsychiatry, 57, 102-110.

Shaffer, D., Gould, M., Fisher, P., Trautman, P., Moreau, D., Kleinman, M., et al. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 339-348.

Simon, G. (2000). Long-term prognosis of depression in primary care. Bulletin of the World Health Organization, 78, 439-445.

Spence, S., & Reinecke, M. (2003). Cognitive approaches to understanding, preventing, and treating child and adolescent depression. In M. Reinecke, & D. Clark (Eds.), Cognitive therapy across the lifespan: Evidence and practice (pp. 358-395). Cambridge, UK: Cambridge University Press.

Teasdale,J. (2004). Mindfulness-based cognitive therapy. In J. Yiend (Ed.), Cognition, emotion, and psychopathology: Theoretical, empirical and clinical directions (pp. 270289). Cambridge, UK: Cambridge University Press.

Treatment for Adolescents with Depression Study (TADS) Team. (2004). Fluoxe-tine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study randomized controlled trial. Journal of the American Medical Association, 292, 807-820.

Treatment for Adolescents with Depression Study (TADS) Team. (2005). The Treatment for Adolescents with Depression Study (TADS): Demographic and clinical characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 28-40.

The TADS Team (2007). The Treatment for Adolescents with Depression Study: Long-term effectiveness and safety outcomes. Archives of General Psychiatry, 64(10), 1132-1144.

Weissman, M., Wolk, S., Goldstein, R., Moreau, D., Adams, P., Greenwald, S., et al. (1999). Depressed adolescents grown up. Journal of the American Medical Association, 281, 1707-1713.

Weisz,J., McCarty, C., & Valeri, S. (2006). Effects of psychotherapy for depression in children and adolescents: A meta-analysis. Psychological Bulletin, 132, 132-149.

Whittington, C., Kendall, T., Fonagy, P., Cottrell, D., Cotgrove, A., & Boddington, E. (2004). Selective serotonin reuptake inhibitors in childhood depression: Systematic review of published versus unpublished data. Lancet, 363, 13411345.

Youngstrom, E., Findling, R., Calabrese, J., Gracious, B., Demeter, C., DelPorto Bedoya, D., et al. (2004). Comparing the diagnostic accuracy of six potential screening instruments for bipolar disorder in youths aged 5 to 17 years. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 847-858.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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