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.


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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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