Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-04T18:05:09.017Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevention and treatment of child and adolescent depression: challenges and opportunities

Part of: Special Articles

Published online by Cambridge University Press:  28 March 2011

B. Vitiello
B. Vitiello*
Affiliation:
National Institute of Mental Health, Bethesda, MD, USA
*
*Address for correspondence: Dr. B. Vitiello, National Institute of Mental Health, Room 7147, 6001 Executive Blvd., Bethesda, MD 20892-9633, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To examine the current theoretical rationale and empirical evidence for preventing and treating major depressive disorder in childhood and adolescence.

Methods.

Selective review of recent controlled investigations on the efficacy and safety of preventive and treatment interventions.

Results.

Even more than in adults, pediatric clinical trials in depression are dominated by symptomatic improvement with non-specific clinical contact (on average, 50% ‘placebo response’). The additional benefit of specific psychotherapeutic or pharmacological treatment is on average modest. Antidepressant medication is effective in speeding up improvement, but more than a third of patients do not reach full remission even after prolonged treatment. The advantage of routinely combining medication with cognitive-behavioral therapy (CBT) is unclear. Depressed suicidal adolescents can benefit from CBT and medications. CBT can protect high-risk youths from developing a depressive episode.

Conclusions.

Effective interventions to prevent and treat depression in youth exist, but their therapeutic benefit appears to be, on average, small, possibly due to the clinical heterogeneity subsumed under the current diagnostic construct of depressive disorder. More specifically, targeted interventions tailored to individual clinical and biological characteristics may result in greater effectiveness and overall efficiency.

Keywords

depressiontreatmentpreventionchildren
Type
Special Article
Information
Epidemiology and Psychiatric Sciences , Volume 20 , Issue 1 , March 2011 , pp. 37 - 43
Copyright
Copyright © Cambridge University Press 2011. This is a work of the U.S. Government and is not subject to Copyright Protection in the United States

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Birmaher, B, Brent, D, the AACAP Work Group on Quality Issues (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry 46, 1503–1526.CrossRefGoogle ScholarPubMed
Brent, D, Emslie, G, Clarke, G, Wagner, K, Asarnow, J, Keller, M, Vitiello, B, Ritz, L, Iyengar, S, Abebe, K, Birmaher, B, Ryan, N, Kennard, B, Hughes, C, DeBar, L, McCracken, J, Strober, M, Suddath, R, Spirito, A, Leonard, H, Porta, G, Onorato, M, Zelazny, J (2008). The Treatment of Adolescents with SSRI-Resistant Depression (TORDIA). A comparison of switch to venlafaxine or to another SSRI, with or without additional cognitive behavioral therapy. Journal of the American Medical Association 299, 901–913.Google Scholar
Brent, D, Greenhill, LL, Compton, S, Emslie, G, Wells, K, Walkup, J, Vitiello, B, Bukstein, O, Stanley, B, Posner, K, Kennard, BD, Cwik, M, Wagner, A, Coffey, B, March, J, Riddle, M, Goldstein, T, Curry, J, Barnett, S, Capasso, L, Zelazny, J, Hughes, J, Shen, S, Gugga, S, Turner, JB (2009). The Treatment of Adolescent Suicide Attempters Study (TASA): predictors of suicidal events in an open treatment trial. Journal of the American Academy of Child and Adolescent Psychiatry 48, 987–996.Google Scholar
Bridge, JA, Birmaher, B, Iyengar, S, Barbe, RP, Brent, DA (2009). Placebo response in randomized controlled trials of antidepressants for pediatric major depressive disorder. American Journal of Psychiatry 166, 42–49.Google Scholar
Bridge, JA, Iyengar, S, Salary, CB, Barbe, RP, Birmaher, B, Pincus, HA, Ren, L, Brent, DA (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. Journal of the American Medical Association 297, 1683–1696.Google Scholar
Byford, S, Barrett, B, Roberts, C, Wilkinson, P, Dubicka, B, Kelvin, RG, White, L, Ford, C, Breen, S, Goodyer, I (2007). Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive behavioural therapy in adolescents with major depression. British Journal of Psychiatry 191, 521–527.Google Scholar
Centers for Disease Control and Prevention (2006). The 10 Leading Causes of Death, United States. National Center for Injury Prevention and Control (http://webappa.cdc.gov/cgi-bin/broker.exe).Google Scholar
Clarke, GN, Hornbrook, M, Lynch, F, Polen, M, Gale, J, Beardslee, W, O'Connor, E, Seeley, J (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry 58, 1127–1134.Google Scholar
Copeland, WE, Shanahan, L, Costello, EJ, Angold, A (2009). Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Archives of General Psychiatry 66, 764–772.Google Scholar
Costello, EJ, Erkanli, A, Angold, A (2006). Is there an epidemic of child and adolescent depression? Journal of Child Psychology and Psychiatry 47, 1263–1271.CrossRefGoogle Scholar
Costello, EJ, Mustillo, S, Erkanli, A, Keeler, G, Angold, A (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry 60, 837–844.Google Scholar
Curry, JF, Rohde, P, Simons, A, Silva, S, Vitiello, B, Kratochvil, CJ, Reinecke, MA, Feeny, N, Wells, KC, Pathak, S, Weller, E, Rosenberg, D, Kennard, BD, Robins, M, Ginsburg, GS, March, JS (2006). Predictors and moderators of acute outcome in the Treatment for Adolescents with Depression Study (TADS). Journal of the American Academy of Child and Adolescent Psychiatry 45, 1427–1439.CrossRefGoogle ScholarPubMed
Domino, ME, Foster, EM, Vitiello, B, Kratochvil, CJ, Burns, BJ, Silva, SG, Reinecke, RA, March, JS (2009). The relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry 48, 711–720.Google Scholar
Emslie, G, Mayes, T, Porta, G, Vitiello, B, Clarke, G, Wagner, KD, Asarnow, JR, Spirito, A, Birmaher, B, Ryan, N, Kennard, B, DeBar, L, McCracken, JT, Strober, M, Onorato, M, Zelazny, J, Keller, M, Iyengar, S, Brent, DA (2010). Treatment of resistant depression in adolescents (TORDIA): week 24 outcomes. American Journal of Psychiatry 167, 782–791.Google Scholar
Emslie, GJ, Kennard, BD, Mayes, TL, Nightingale-Teresi, J, Carmody, T, Hughes, CW, Rush, AJ, Tao, R, Rintelmann, JW (2008). Fluoxetine versus placebo in preventing relapse of major depression in children and adolescents. American Journal of Psychiatry 165, 459–467.CrossRefGoogle ScholarPubMed
Fergusson, DM, Horwood, LJ, Ridder, EM, Beautrais, AL (2005). Subthreshold depression in adolescence and mental health outcomes in adulthood. Archives of General Psychiatry 62, 66–72.Google Scholar
Fournier, JC, DeRubeis, RJ, Shelton, RC, Hollon, SD, Amsterdam, JD, Gallop, R (2009). Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. Journal of Consulting and Clinical Psychology 77, 775–787.Google Scholar
Garber, J, Clarke, GN, Weersing, VR, Beardslee, WR, Brent, DA, Gladstone, TR, DeBar, LL, Lynch, FL, D'Angelo, E, Hollon, SD, Shamseddeen, W, Iyengar, S (2009). Prevention of depression in at-risk adolescents: a randomized controlled trial. Journal of the American Medical Association 301, 2215–2224.Google Scholar
Gibbons, RD, Hur, K, Bhaumik, DK, Mann, JJ (2006). The relationship between antidepressant prescription rates and rate of early adolescent suicide. American Journal of Psychiatry 163, 1–7.Google Scholar
Goodyer, I, Dubicka, B, Wilkinson, P, Kelvin, R, Roberts, C, Byford, S, Breen, S, Ford, C, Barrett, B, Leech, A, Rothwell, J, White, L, Harrington, R (2007). Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomized controlled trial. British Medical Journal 335, 142.Google Scholar
Hammad, TA, Laughren, T, Racoosin, J (2006). Suicidality in pediatric patients treated with antidepressant drugs. Archives of General Psychiatry 63, 332–339.CrossRefGoogle ScholarPubMed
Hollon, SD, Stewart, MO, Strunk, D (2006). Enduring effects of cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology 57, 285–315.Google Scholar
Ising, M, Lucae, S, Biner, EB, Bettecken, T, Uhr, M, Ripke, S, Kohli, MA, Hennings, JM, Horstmann, S, Kloiber, S, Menke, A, Bondy, B, Rupprecht, R, Domschke, K, Baune, BT, Arolt, V, Rush, AJ, Holsboer, F, Müller-Myhsok, B (2009). A genomewide association study points to multiple loci that predict antidepressant drug treatment outcome in depression. Archives of General Psychiatry 66, 966–975.Google Scholar
Kennard, B, Silva, SG, Tonev, S, Rohde, P, Hughes, JL, Vitiello, B, Kratochvil, CJ, Curry, JF, Emslie, GJ, Reinecke, M, March, J (2009). Remission and recovery in the Treatment for Adolescents with Depression Study (TADS): acute and long-term outcomes. Journal of the American Academy of Child and Adolescent Psychiatry 48, 186–195.Google Scholar
Kennard, BD, Emslie, GJ, Mayes, TL, Nightingale-Teresi, J, Nakonezny, PA, Hughes, JL, Jones, JM, Tao, R, Stewart, SM, Jarrett, RB (2008). Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder. Journal of the American Academy of Child and Adolescent Psychiatry 47, 1395–1404.Google Scholar
Kessler, RC, Aguilar-Gaxiola, S, Alonso, J, Chatterji, S, Lee, S, Ormel, J, Ustün, TB, Wang, PS (2009). The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiologia e Psichiatria Sociale 18, 23–33.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.CrossRefGoogle ScholarPubMed
Lynch, FL, Hornbrook, M, Clarke, GN, Perrin, N, Polen, MR, O'Connor, E, Dickerson, J (2005). Cost-effectiveness of an intervention to prevent depression in at-risk teens. Archives of General Psychiatry 62, 1241–1248.CrossRefGoogle ScholarPubMed
March, JS, Vitiello, B (2009). Clinical messages from the Treatment for Adolescents with Depression Study (TADS). American Journal of Psychiatry 166, 1118–1123.Google Scholar
Mathers, C, Boerma, T, Ma Fat, D (2005). The global burden of disease: 2004 update. World Health Organization Press (http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf).Google Scholar
Merikangas, KR, He, J-P, Brody, D, Fisher, PW, Bourdon, K, Koretz, DS (2010). Prevalence and treatment of mental disorders among US children in the 2001-2004 NHANES. Pediatrics 125, 75–81.CrossRefGoogle ScholarPubMed
Owens, PL, Thompson, J, Elixhauser, A, Ryan, K (2003). Care of Children and Adolescents in U.S. Hospitals. Agency for Healthcare Research and Quality: Rockville, MD. HCUP Fact Book N0.4, AHRQ Publication No. 04-0004.Google Scholar
Regeer, EJ, Krabbendam, L, de Graaf, R, Ten Have, M, Nolen, WA, van Os, J (2006). A prospective study of the transition rates of subthreshold (hypo) mania and depression in the general population. Psychological Medicine 36, 619–627.Google Scholar
Sourander, A, Klomek, AB, Niemelä, S, Haavisto, A, Gyllenberg, D, Helenius, H, Sillanmäki, L, Ristkari, T, Kumpulainen, K, Tamminen, T, Moilanen, I, Piha, J, Almqvist, F, Gould, MS (2009). Childhood predictors of completed and severe suicide attempts: findings from the Finnish 1981 Birth Cohort Study. Archives of General Psychiatry 66, 398–406.Google Scholar
Stanley, B, Brown, G, Brent, D, Wells, K, Poling, K, Curry, J, Kennard, BD, Wagner, A, Cwik, M, Klomek, AB, Goldstein, T, Vitiello, B, Barnett, S, Daniel, S, Hughes, J (2009). Cognitive-Behavioral Therapy for Suicide Prevention (CBT-SP): treatment model, feasibility, and acceptability. Journal of the American Academy of Child and Adolescent Psychiatry 48, 1005–1013.Google Scholar
TADS Team (2004). The Treatment for Adolescents with Depression Study (TADS): short-term effectiveness and safety outcomes. Journal of the American Medical Association 292, 807–820.Google Scholar
TADS Team (2007). The Treatment for Adolescents with Depression Study (TADS): long-term effectiveness and safety outcomes. Archives of General Psychiatry 64, 1132–1144.Google Scholar
TADS Team (2009). The Treatment for Adolescents with Depression Study (TADS): outcomes over one year of naturalistic follow-up. American Journal of Psychiatry 166, 1141–1149.Google Scholar
U.S. Preventive Services Task Force (2009). Screening and treatment for major depressive disorder in children and adolescents: US preventive services task force recommendation statement. Pediatrics 123, 1223–1228.Google Scholar
Vitiello, B (2009). Combined cognitive-behavioural therapy and pharmacotherapy for adolescent depression: does it improve outcomes compared with monotherapy? CNS Drugs 23, 271–280.Google Scholar
Vitiello, B, Brent, D, Greenhill, LL, Emslie, G, Wells, K, Walkup, JT, Stanley, B, Bukstein, O, Kennard, BD, Compton, S, Coffey, B, Cwik, MF, Posner, K, Wagner, A, March, JS, Riddle, M, Goldstein, T, Curry, J, Capasso, L, Mayes, T, Shen, S, Gugga, SS, Turner, JB, Barnett, S, Zelazny, J (2009 a). Depressive symptoms and clinical status during the Treatment of Adolescent Suicide Attempters Study (TASA). Journal of the American Academy of Child and Adolescent Psychiatry 48, 997–1004.Google Scholar
Vitiello, B, Emslie, G, Clarke, G, Wagner, KD, Asarnow, JR, Keller, M, Birmaher, B, Ryan, N, Kennard, B, Mayes, T, DeBar, L, Lynch, F, Dickerson, J, Strober, M, Suddath, R, McCracken, JT, Spirito, A, Onorato, M, Zelazny, J, Porta, G, Iyengar, S, Brent, D (2010). Long-term outcome of adolescent depression initially resistant to SSRI treatment. Journal of Clinical Psychiatry. [Epub ahead of Print on Nov. 16]Google Scholar
Vitiello, B, Pearson, JL (2008). An adolescent at high risk for suicidal behavior. American Journal of Psychiatry 165, 323–328.Google Scholar
Vitiello, B, Rohde, P, Silva, SG, Wells, KC, Casat, C, Waslick, BD, Simons, A, Reinecke, MA, Weller, EB, Kratochvil, CJ, Walkup, J, Pathak, S, Robins, M, March, JS (2006). Effects of treatment on level of functioning, global health, and quality of life in depressed adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 45, 1419–1426.Google Scholar
Vitiello, B, Silva, S, Rohde, P, Kratochvil, C, Kennard, B, Reinecke, M, Mayes, T, Posner, K, May, DE, March, JS (2009 b). Suicidal events in the Treatment for Adolescents with Depression Study (TADS). Journal of Clinical Psychiatry 70, 741–747.Google Scholar
Weissman, MM, Pilowsky, DJ, Wickramaratne, PJ, Talati, A, Wisniewski, SR, Fava, M, Hughes, CW, Garber, J, Malloy, E, King, CA, Cerda, G, Sood, AB, Alpert, JE, Trivedi, MH, Rush, AJ (2006). STAR*D-Child Team. Remissions in maternal depression and child psychopathology: a STAR*D-child report. Journal of the American Medical Association 295, 1389–1398.Google Scholar
Weisz, JR, McCarthy, CA, Valeri, SM (2006). Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychological Bulletin 132, 132–149.Google Scholar
Zimmermann, P, Brückl, T, Nocon, A, Pfister, H, Lieb, R, Wittchen, HU, Holsboer, F, Angst, J (2009). Heterogeneity of DSM-IV major depressive disorder as a consequence of subthreshold bipolarity. Archives of General Psychiatry 66, 1341–1352.Google Scholar