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Haack LM, Armstrong CC, Travis K, Aguilera A, Darrow SM. HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let's Text!): Pilot Feasibility and Acceptability Study. JMIR Ment Health 2024; 11:e49317. [PMID: 38373030 PMCID: PMC10912989 DOI: 10.2196/49317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants' texts. OBJECTIVE This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system's impact on adolescents' group CBT engagement and, ultimately, depression outcomes. METHODS Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. RESULTS All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. CONCLUSIONS Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants' qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research.
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Affiliation(s)
- Lauren M Haack
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Courtney C Armstrong
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Kate Travis
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Adrian Aguilera
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States
| | - Sabrina M Darrow
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
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Chang JC, Hai-Ti-Lin, Wang YC, Gau SSF. Treatment-resistant depression in children and adolescents. PROGRESS IN BRAIN RESEARCH 2023; 281:1-24. [PMID: 37806711 DOI: 10.1016/bs.pbr.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Major depressive disorder (MDD) in children and adolescents is a significant health problem, causing profound impairments in social, academic, and family functioning and substantial morbidity and mortality. Up to 15% of children and adolescents suffer from MDD, and a proportion, around 30 to 40% of them, failed to respond to initial selective serotonin reuptake inhibitor (SSRI) treatment. The only evidence-based recommendation is medication switching to another SSRI and augmentation with cognitive behavioral therapy. Newly developing treatment, including ketamine, transcranial magnetic stimulation, psychotherapy other than cognitive behavioral therapy, and combined pharmacotherapy with other interventions, requires further longitudinal controlled trials regarding efficacy and safety in this vulnerable population.
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Affiliation(s)
- Jung-Chi Chang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Ti-Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Wang
- Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Strawn JR, Mills JA, Suresh V, Mayes T, Gentry MT, Trivedi M, Croarkin PE. The impact of age on antidepressant response: A mega-analysis of individuals with major depressive disorder. J Psychiatr Res 2023; 159:266-273. [PMID: 36774767 PMCID: PMC9993423 DOI: 10.1016/j.jpsychires.2023.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Understanding how age affects antidepressant response in patients with major depressive disorder has been complicated by small and heterogeneous studies. Yet, understanding how age-across the lifespan-contributes to variation in response could inform treatment selection across the lifespan. This study sought to identify how age impacts antidepressant response using participant-level data from large, NIH-sponsored trials in individuals with MDD aged 12-74 years. MATERIALS AND METHODS Participant-level data were abstracted from three NIH-sponsored trials of pharmacotherapy (Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Study, Treatment of Adolescent Depression Study (TADS), and the Combining Medications to Enhance Depression Outcomes Study (COMED)) in patients with MDD. Bayesian Hierarchical Models (BHMs) of individual treatment trajectories were developed using Hamiltonian Monte Carlo No U-Turn Sampling. The individual trajectory of improvement in depressive symptoms (Clinical Global Impression-Severity [CGI-S] and CGI-S equivalent from COMED) was modeled across studies and across individuals with logarithmic trend "random effects" coefficients BHMs. Age and sex (and their interaction) were examined categorically across patients. RESULTS Study participants (N = 907) were 29.7 ± 17 years of age, 66.3% women, and had a mean baseline CGI-S score of 4.6 ± 0.9. Patients ≤21 years and those >55 years had slower and less response to pharmacotherapy compared to those aged 21-35. Additionally, women improved more than men, and this effect did not differ across ages. DISCUSSION The patient's age should be considered in predicting antidepressant response, particularly in older and younger individuals who may benefit from other interventions to enhance treatment response.
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Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45219, USA; Department of Pediatrics, Divisions of Clinical Pharmacology and Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267, USA.
| | - Jeffrey A Mills
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Vikram Suresh
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Taryn Mayes
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Madhukar Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Courtney DB, Watson P, Krause KR, Chan BWC, Bennett K, Gunlicks-Stoessel M, Rodak T, Neprily K, Zentner T, Szatmari P. Predictors, Moderators, and Mediators Associated With Treatment Outcome in Randomized Clinical Trials Among Adolescents With Depression: A Scoping Review. JAMA Netw Open 2022; 5:e2146331. [PMID: 35103789 PMCID: PMC8808324 DOI: 10.1001/jamanetworkopen.2021.46331] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/08/2021] [Indexed: 12/26/2022] Open
Abstract
Importance The application of precision medicine principles for the treatment of depressive disorders in adolescents requires an examination of the variables associated with depression outcomes in randomized clinical trials (RCTs). Objective To describe predictors, moderators, and mediators associated with outcomes in RCTs for the treatment of depressive disorders in adolescents. Evidence Review A scoping review of RCTs for the treatment of depression in adolescents was conducted. Databases searched included MEDLINE, Embase, APA PsycInfo, and CINAHL. Included publications tested predictors, moderators, and/or mediators associated with depression symptom outcomes (eg, symptom reduction, response, remission) in RCTs pertaining to the treatment of adolescents, ages 13 to 17 years. Predictors were defined as variables that were associated with depression outcomes, independent of treatment group. Moderators were defined as baseline variables that were associated with differential outcomes between treatment groups. Mediators were defined by a formal mediation analysis. In duplicate, variables were extracted and coded with respect to analysis type (univariable or multivariable), statistical significance, direction of effect size, reporting of a priori hypotheses, and adjustment for multiple comparisons. Aggregated results were summarized by variable domain and RCT sample. Findings Eighty-one articles reporting on variables associated with outcomes across 33 RCTs were identified, including studies of biological (10 RCTs), psychosocial (18 RCTs), and combined (4 RCTs) treatments as well as a service delivery model (1 RCT). Fifty-three variable domains were tested as baseline predictors of depression outcome, 41 as moderators, 19 as postbaseline predictors, and 5 as mediators. Variable domains that were reported as significant in at least 3 RCTs included age, sex/gender, baseline depression severity, early response to treatment, sleep changes, parent-child conflict, overall psychopathology, suicidal ideation, hopelessness, functional impairment, attendance at therapy sessions, and history of trauma. Two publications reported a priori hypotheses and adjustment for multiple comparisons, both finding that baseline depression severity and family conflict were associated with poorer outcomes. Conclusions and Relevance This review identified commonly researched variables requiring more scrutiny as well as underresearched variables to inform future study designs. Further efforts to discover predictors, moderators, and mediators associated with treatment response have great potential to optimize care for adolescents with depression.
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Affiliation(s)
- Darren B. Courtney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Priya Watson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Terri Rodak
- Centre for Addiction and Mental Health Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kirsten Neprily
- School and Applied Child Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Tabitha Zentner
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Strawn JR, Mills JA, Suresh V, Peris T, Walkup JT, Croarkin PE. Combining selective serotonin reuptake inhibitors and cognitive behavioral therapy in youth with depression and anxiety. J Affect Disord 2022; 298:292-300. [PMID: 34728290 PMCID: PMC8674898 DOI: 10.1016/j.jad.2021.10.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/17/2021] [Accepted: 10/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Treatment studies of children and adolescents with internalizing disorders suggest that the combination of a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy (CBT) consistently produces greater improvement than either treatment alone. We sought to determine how response to combined treatment varies across disorders (anxiety versus depression), and by specific patient characteristics. METHODS Three large National Institutes of Health-funded trials of children and adolescents with major depression (n = 2) and anxiety disorders (n = 1) were evaluated, each comparing CBT + SSRI to SSRI only, Bayesian Hierarchical Models (BHMs) were used, for endpoint response, time course of response and predictors of response in participants who received SSRI or SSRI+CBT. RESULTS SSRI+CBT significantly decreased symptoms by week 4 (p<0.001) across disorders. This improvement continued at week 8 and 12 (p<0.001); however, the additive benefit of CBT over SSRI monotherapy was not statistically significant until week 12 (p<0.001). The fastest response to SSRI+CBT was for patients who were younger, with milder baseline anxiety/depression symptoms and depressive disorders. The slowest response for SSRI+CBT was for boys, adolescents, minoritized children, those with severe symptoms and externalizing disorders. LIMITATIONS Limitations included inconsistent moderators, variation in the number of observations over time and a lack of genetic or pharmacokinetic variables related to SSRI exposure across studies. CONCLUSIONS The superiority of SSRI+CBT for youth with depression and anxiety is further supported. For purposes of rapid and greater relief, combination treatment is the superior approach across anxiety and depression and is robust to a range of participant characteristics. However, the added value of CBT (with an SSRI) occurs late in treatment. These findings represent a step towards understanding heterogeneity of treatment response and raise the possibility that interventions could be better tailored or adapted based on patient characteristics.
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Affiliation(s)
- Jeffrey R. Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH,Department of Pediatrics, Divisions of Clinical Pharmacology and Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,To whom correspondence should be sent: Jeffrey R. Strawn, MD, Anxiety Disorders Research Program, Dept. of Psychiatry & Behavioral Neuroscience, University of Cincinnati, 260 Stetson Street, Suite 3200, Cincinnati, Ohio 45267-0559, Tel: 513.558.4315, Fax:513.558.3399,
| | - Jeffrey A. Mills
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, Ohio
| | - Vikram Suresh
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, Ohio
| | - Tara Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - John T. Walkup
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine; Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Paul E. Croarkin
- Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN
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6
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van den Heuvel MWH, Bodden DHM, Smit F, Stikkelbroek Y, Weisz JR, Moerbeek M, Engels RCME. Relative Effectiveness of CBT-Components and Sequencing in Indicated Depression Prevention for Adolescents: A Cluster-Randomized Microtrial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021:1-16. [PMID: 34644218 DOI: 10.1080/15374416.2021.1978296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Cognitive Behavioral Therapy (CBT) was dismantled into four modules of three sessions each: cognitive restructuring (Think), behavioral activation (Act), problem solving (Solve) and relaxation (Relax). We investigated the modules' relative effectiveness in indicated depression prevention for adolescents and examined variations in sequencing of these modules. METHOD We performed a pragmatic cluster-randomized microtrial with four parallel conditions: (1) Think-Act-Relax-Solve (n = 14 clusters, n = 81 participants); (2) Act-Think-Relax-Solve (n = 13, n = 69); (3) Solve-Act-Think-Relax (n = 13, n = 77); and (4) Relax-Solve-Act-Think (n = 12, n = 55). The sample consisted of 282 Dutch adolescents with elevated depressive symptoms (Mage = 13.8; 55.7% girls, 92.9% Dutch). In total 52 treatment groups were randomized as a cluster. Assessments were conducted at baseline, after each module and at 6-month follow-up with depressive symptoms as primary outcome. RESULTS None of the modules (Think, Act, Solve, Relax) was associated with a significant decrease in depressive symptoms after three sessions and no significant differences in effectiveness were found between the modules. All sequences of modules were associated with a significant decrease in depressive symptoms at post-intervention, except the sequence Relax-Solve-Act-Think. At 6-month follow-up, all sequences showed a significant decrease in depressive symptoms. No significant differences in effectiveness were found between the sequences at post-intervention and 6-month follow-up. CONCLUSIONS Regardless of the CBT technique provided, one module of three sessions may not be sufficient to reduce depressive symptoms. The sequence in which the CBT components cognitive restructuring, behavioral activation, problem solving and relaxation are offered, does not appear to significantly influence outcomes at post- intervention or 6-month follow-up. ABBREVIATIONS CDI-2:F: Children's Depression Inventory-2 Full-length version; CDI-2:S: Children's Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax and repeat.
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Affiliation(s)
- Marieke W H van den Heuvel
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam.,Department of Mental Health and Prevention, Trimbos Institute, Netherlands Institute of Mental Health and Addiction
| | - Denise H M Bodden
- Child and Adolescent Studies, Utrecht University.,Altrecht, Child and Youth Psychiatry
| | - Filip Smit
- Department of Mental Health and Prevention, Trimbos Institute, Netherlands Institute of Mental Health and Addiction.,Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers.,Department of Clinical, Neuro and Developmental Psychology, VU University
| | - Yvonne Stikkelbroek
- Child and Adolescent Studies, Utrecht University.,GGZ Oost Brabant, Depression Expertise Center, Youth Psychiatry
| | | | - Mirjam Moerbeek
- Department of Methodology and Statistics, Utrecht University
| | - Rutger C M E Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam
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7
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Krause KR, Courtney DB, Chan BWC, Bonato S, Aitken M, Relihan J, Prebeg M, Darnay K, Hawke LD, Watson P, Szatmari P. Problem-solving training as an active ingredient of treatment for youth depression: a scoping review and exploratory meta-analysis. BMC Psychiatry 2021; 21:397. [PMID: 34425770 PMCID: PMC8383463 DOI: 10.1186/s12888-021-03260-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Problem-solving training is a common ingredient of evidence-based therapies for youth depression and has shown effectiveness as a versatile stand-alone intervention in adults. This scoping review provided a first overview of the evidence supporting problem solving as a mechanism for treating depression in youth aged 14 to 24 years. METHODS Five bibliographic databases (APA PsycINFO, CINAHL, Embase, MEDLINE, Web of Science) and the grey literature were systematically searched for controlled trials of stand-alone problem-solving therapy; secondary analyses of trial data exploring problem-solving-related concepts as predictors, moderators, or mediators of treatment response within broader therapies; and clinical practice guidelines for youth depression. Following the scoping review, an exploratory meta-analysis examined the overall effectiveness of stand-alone problem-solving therapy. RESULTS Inclusion criteria were met by four randomized trials of problem-solving therapy (524 participants); four secondary analyses of problem-solving-related concepts as predictors, moderators, or mediators; and 23 practice guidelines. The only clinical trial rated as having a low risk of bias found problem-solving training helped youth solve personal problems but was not significantly more effective than the control at reducing emotional symptoms. An exploratory meta-analysis showed a small and non-significant effect on self-reported depression or emotional symptoms (Hedges' g = - 0.34; 95% CI: - 0.92 to 0.23) with high heterogeneity. Removing one study at high risk of bias led to a decrease in effect size and heterogeneity (g = - 0.08; 95% CI: - 0.26 to 0.10). A GRADE appraisal suggested a low overall quality of the evidence. Tentative evidence from secondary analyses suggested problem-solving training might enhance outcomes in cognitive-behavioural therapy and family therapy, but dedicated dismantling studies are needed to corroborate these findings. Clinical practice guidelines did not recommend problem-solving training as a stand-alone treatment for youth depression, but five mentioned it as a treatment ingredient. CONCLUSIONS On its own, problem-solving training may be beneficial for helping youth solve personal challenges, but it may not measurably reduce depressive symptoms. Youth experiencing elevated depressive symptoms may require more comprehensive psychotherapeutic support alongside problem-solving training. High-quality studies are needed to examine the effectiveness of problem-solving training as a stand-alone approach and as a treatment ingredient.
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Affiliation(s)
- Karolin R Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, UK.
| | - Darren B Courtney
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Sarah Bonato
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Madison Aitken
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jacqueline Relihan
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Matthew Prebeg
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Karleigh Darnay
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
| | - Lisa D Hawke
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Priya Watson
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
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8
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Dimick MK, Hird MA, Fiksenbaum LM, Mitchell RHB, Goldstein BI. Severe anhedonia among adolescents with bipolar disorder is common and associated with increased psychiatric symptom burden. J Psychiatr Res 2021; 134:200-207. [PMID: 33412423 DOI: 10.1016/j.jpsychires.2020.12.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/06/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anhedonia, a deficit in the ability to experience pleasure, is a cardinal symptom of major depressive episodes. In contrast to adolescent major depressive disorder, there is limited research examining anhedonia in the context of depression among adolescents with bipolar disorder (BD). We therefore examined clinical characteristics of anhedonia in a large sample of adolescents with BD. METHODS Participants were 197 adolescents, aged 13-20 years old, with BD type I, II or not otherwise specified. Diagnoses were determined using a semi-structured interview. Anhedonia severity was rated from one to six on the Depression Rating Scale (DRS). Adolescents were divided into "severe" and "non-severe" anhedonia groups based on the DRS item scoring. The association of anhedonia with clinical and demographic variables was evaluated in univariate analyses followed by logistic regression analyses for variables with p ≤ 0.1. RESULTS Threshold anhedonia was evident among 90.9% during their most severe depressive episode. Significant factors associated with severe most severe lifetime anhedonia ("lifetime anhedonia") included: female sex, lifetime history of self-injurious behavior, physical abuse, affective lability, higher lifetime depression severity, comorbid anxiety disorders, family history of ADHD, and second-generation antipsychotic use. In regression analyses, severe lifetime anhedonia was independently associated with female sex, comorbid anxiety disorders, most severe lifetime mania severity, and lifetime second-generation antipsychotic use. CONCLUSION The vast majority of adolescents with BD experience anhedonia. More severe anhedonia is associated with indicators of greater illness severity. Future research is warranted to evaluate the neurobiological underpinnings of anhedonia among adolescents with BD.
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Affiliation(s)
- Mikaela K Dimick
- Department of Pharmacology, University of Toronto, ON, Canada; Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Megan A Hird
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, ON, Canada
| | - Lisa M Fiksenbaum
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rachel H B Mitchell
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, ON, Canada
| | - Benjamin I Goldstein
- Department of Pharmacology, University of Toronto, ON, Canada; Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, ON, Canada.
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9
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Suresh V, Mills JA, Croarkin PE, Strawn JR. What next? A Bayesian hierarchical modeling re-examination of treatments for adolescents with selective serotonin reuptake inhibitor-resistant depression. Depress Anxiety 2020; 37:926-934. [PMID: 32579280 PMCID: PMC7595266 DOI: 10.1002/da.23064] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Psychiatrists frequently struggle with how to sequence treatment for depressed adolescents who do not respond to an adequate trial of a selective serotonin reuptake inhibitor (SSRI). This study leveraged recent statistical and computational advances to create Bayesian hierarchal models (BHMs) of response in the treatment of SSRI-resistant depression in adolescents study to inform treatment planning. METHODS BHMs of individual treatment trajectories were developed and estimated using Hamiltonian Monte Carlo no u-turn sampling. From the Monte Carlo pseudorandom sample, 95% credible intervals, means, posterior tail probabilities, and so forth, were determined. Then, for the random effects model, posterior tail probabilities were used to create Bayesian two-tailed p values to evaluate the null hypotheses: no difference in efficacy between SSRIs and venlafaxine. The robustness of the results was examined using the fixed effects model of treatment comparisons. RESULTS In patients not receiving cognitive behavioral therapy (CBT; n = 168), SSRIs produced greater and faster improvement in depressive symptoms compared to venlafaxine (p = .015). No differences in response or trajectory of response for symptoms of anxiety were detected between SSRIs and venlafaxine (p = .168). For patients receiving CBT (n = 162), SSRIs and venlafaxine produced similar improvements in symptoms of anxiety and depression. CONCLUSIONS Findings from this novel computational approach suggest that a second trial of an SSRI is warranted for depressed adolescents who fail to respond to initial SSRI treatment.
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Affiliation(s)
- Vikram Suresh
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, Ohio 45221
| | - Jeffrey A. Mills
- Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, Ohio 45221
| | - Paul E. Croarkin
- Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN
| | - Jeffrey R. Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45219,Department of Pediatrics, Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267
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10
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Ghaziuddin N, Shamseddeen W, Gettys G, Ghaziuddin M. Electroconvulsive Therapy for the Treatment of Severe Mood Disorders During Adolescence: A Retrospective Chart Review. J Child Adolesc Psychopharmacol 2020; 30:235-243. [PMID: 32125885 DOI: 10.1089/cap.2019.0054] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: Electroconvulsive therapy (ECT) is a well-recognized treatment of refractory mood disorders in adults. However, relatively little is known about its use for similar conditions in adolescents. Based on a chart review, we describe its use and outcome in a sample of adolescents with severe, refractory mood disorders (unipolar or bipolar disorder) hospitalized in an academic medical center. Methods: The sample was drawn from referrals to an adolescent psychiatry service. After obtaining approval from the ethics board, medical records of 54 adolescents with refractory mood disorder were examined. Participants (males 24, females 30; mean age 15.8 ± 1.5 years) had received their first course of ECT before the age of 18 years during the period 1996-2010. Response to treatment was examined after the initial treatment and during a 1-year follow-up. Results: Following the index course of ECT (mean number of treatments = 13.7 ± 6.3), a 52.8% response rate (defined as a Clinical Global Impressions [CGI] score ≤2) was noted, while 15.1% achieved remission (CGI = 1). The response rate was 82.4% after a 1-year follow-up with a remission rate of 23.5%. The Children's Depression Rating scores declined significantly from pre-ECT to the end of the index course (70.7 ± 16.4 to 52.5 ± 18; p ≤ 0.00). A reduction in suicidal ideation and self-injurious behaviors along with increased school attendance was noted. Cognition, monitored by the Mini-Mental State Examination, did not decline significantly. Minor side effects were limited to the day of the treatment. Prolonged seizures (>2 minutes) were common during ECT (74% of subjects experienced one or more). The only side effect noted at the 1-year follow-up was self-reported memory loss involving events during and around the index treatment course. Conclusions: In this severely impaired sample of adolescents, ECT was found to decrease suicidal behavior, reduce depressive symptoms, and improve overall functioning, as indexed by school attendance at follow-up after 1 year. Prospective studies using large samples are needed to determine its effectiveness and safety in refractory mood disorders in adolescents.
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Affiliation(s)
- Neera Ghaziuddin
- Department of Psychiatry, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Wael Shamseddeen
- Department of Psychiatry, University of Michigan Hospitals, Ann Arbor, Michigan, USA.,Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - George Gettys
- Department of Psychiatry, Rosalind Franklin University, North Chicago, Illinois, USA
| | - Mohammad Ghaziuddin
- Department of Psychiatry, University of Michigan Hospitals, Ann Arbor, Michigan, USA
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11
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Dwyer JB, Stringaris A, Brent DA, Bloch MH. Annual Research Review: Defining and treating pediatric treatment-resistant depression. J Child Psychol Psychiatry 2020; 61:312-332. [PMID: 32020643 PMCID: PMC8314167 DOI: 10.1111/jcpp.13202] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Adolescent major depressive disorder (MDD) is a significant health problem, associated with substantial morbidity, cost, and mortality. Depression is a significant risk factor for suicide, which is now the second leading cause of death in young people. Up to twenty per cent of adolescents will experience MDD before adulthood, and while a substantial proportion will improve with standard-of-care treatments (psychotherapy and medication), roughly one third will not. METHODS Here, we have reviewed the literature in order to discuss the concept of treatment-resistant depression (TRD) in adolescence, examine risk factors, diagnostic difficulties, and challenges in evaluating symptom improvement, and providing guidance on how to define adequate medication and psychotherapy treatment trials. RESULTS We propose a staging model for adolescent TRD and review the treatment literature. The evidence base for first- and second-line treatments primarily derives from four large pediatric clinical trials (TADS, TORDIA, ADAPT, and IMPACT). After two medications and a trial of evidence-based psychotherapy have failed to alleviate depressive symptoms, the evidence becomes quite thin for subsequent treatments. Here, we review the evidence for the effectiveness of medication switches, medication augmentation, psychotherapy augmentation, and interventional treatments (i.e., transcranial magnetic stimulation, electroconvulsive therapy, and ketamine) for adolescent TRD. Comparisons are drawn to the adult TRD literature, and areas for future pediatric depression research are highlighted. CONCLUSIONS As evidence is limited for treatments in this population, a careful consideration of the known risks and side effects of escalated treatments (e.g., mood stabilizers and atypical antipsychotics) is warranted and weighed against potential, but often untested, benefits.
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Affiliation(s)
- Jennifer B. Dwyer
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA,Yale Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Argyris Stringaris
- Mood Brain and Development Unit, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Michael H. Bloch
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA,Yale Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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12
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Tymofiyeva O, Yuan JP, Huang CY, Connolly CG, Henje Blom E, Xu D, Yang TT. Application of machine learning to structural connectome to predict symptom reduction in depressed adolescents with cognitive behavioral therapy (CBT). NEUROIMAGE-CLINICAL 2019; 23:101914. [PMID: 31491813 PMCID: PMC6627980 DOI: 10.1016/j.nicl.2019.101914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/14/2019] [Accepted: 06/29/2019] [Indexed: 12/29/2022]
Abstract
Purpose Adolescent major depressive disorder (MDD) is a highly prevalent, incapacitating and costly illness. Many depressed teens do not improve with cognitive behavioral therapy (CBT), a first-line treatment for adolescent MDD, and face devastating consequences of increased risk of suicide and many negative health outcomes. “Who will improve with CBT?” is a crucial question that remains unanswered, and treatment planning for adolescent depression remains biologically unguided. The purpose of this study was to utilize machine learning applied to patients' brain imaging data in order to help predict depressive symptom reduction with CBT. Methods We applied supervised machine learning to diffusion MRI-based structural connectome data in order to predict symptom reduction in 30 depressed adolescents after three months of CBT. A set of 21 attributes was chosen, including the baseline depression score, age, gender, two global network properties, and node strengths of brain regions previously implicated in depression. The practical and robust J48 pruned tree classifier was utilized with a 10-fold cross-validation. Results The classification resulted in an 83% accuracy of predicting depressive symptom reduction. The resulting tree of size seven with only three attributes highlights the role of the right thalamus in predicting depressive symptom reduction with CBT. Additional analysis showed a significant negative correlation between the change in the depressive symptoms and the node strength of the right thalamus. Conclusions Our results demonstrate that a machine learning algorithm that exclusively uses structural connectome data and the baseline depression score can predict with a high accuracy depressive symptom reduction in adolescent MDD with CBT. This knowledge can help improve treatment planning for adolescent depression. Machine learning predicted symptom reduction in depressed teens with 83% accuracy. Resulting prunned classification tree size was 7, with only 3 attributes. Change in depression symptoms correlated with node strength of the right thalamus.
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Affiliation(s)
- Olga Tymofiyeva
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 1700 4th Street, BH102, San Francisco, CA 94143, USA.
| | - Justin P Yuan
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 1700 4th Street, BH102, San Francisco, CA 94143, USA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143, USA
| | - Colm G Connolly
- Department of Psychiatry and the Langley Porter Psychiatric Institute, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Biomedical Sciences, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL 32306, USA
| | - Eva Henje Blom
- Department of Psychiatry and the Langley Porter Psychiatric Institute, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Clinical Science/Child- and Adolescent Psychiatry, Umeå University, SE-901 87 Umeå, Sweden
| | - Duan Xu
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 1700 4th Street, BH102, San Francisco, CA 94143, USA
| | - Tony T Yang
- Department of Psychiatry and the Langley Porter Psychiatric Institute, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
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13
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Dismantling the relative effectiveness of core components of cognitive behavioural therapy in preventing depression in adolescents: protocol of a cluster randomized microtrial. BMC Psychiatry 2019; 19:200. [PMID: 31248384 PMCID: PMC6598366 DOI: 10.1186/s12888-019-2168-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both depressive disorder and subclinical depressive symptoms during adolescence are a major public health concern. Therefore, it is important that depression is detected at an early stage and is treated preventively. Prevention based on the principles of Cognitive Behavioural Therapy (CBT) has proven to be the most effective, however research has mainly focused on the effectiveness of "prevention packages" consisting of multiple CBT-components, rather than on the distinct CBT-components. This study will evaluate the relative effectiveness of four core components of CBT (cognitive restructuring (CR), behavioural activation (BA), problem solving (PS) and relaxation (RE)). In addition the relative (cost-)effectiveness of four different sequences of these components will be evaluated: (1) CR - BA - RE - PS, (2) BA - CR - RE - PS, (3) PS - GA - CR - RE and (4) RE - PS - BA - CR. METHODS We will perform a non-blinded multisite cluster randomized prevention microtrial with four parallel conditions consisting of the four sequences. The four sequences of components will be offered in groups of high school students with elevated depressive symptoms. For each CBT-component a module of three sessions is developed. Assessments will be conducted at baseline, after each CBT-component, prior to each session, at post-intervention and at 6-month follow-up. Potential moderators and mediators will be evaluated exploratively to shed light on for whom the (sequences of) CBT-components are most effective and how effects are mediated. DISCUSSION The potential value of the study is insight in the relative effectiveness of the four most commonly used CBT-components and four different sequences, and possible moderators and mediators in the prevention of depression among adolescents. This knowledge can be used to optimize and personalize CBT-programs. TRIAL REGISTRATION The study is registered in the Dutch Trial Register (Trial NL5584 / NTR6176) on October 13, 2016.
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14
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A Pilot Randomised Controlled Trial of a School-Based Resilience Intervention to Prevent Depressive Symptoms for Young Adolescents with Autism Spectrum Disorder: A Mixed Methods Analysis. J Autism Dev Disord 2018; 47:3458-3478. [PMID: 28770525 DOI: 10.1007/s10803-017-3263-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite increased depression in adolescents with Autism Spectrum Disorder (ASD), effective prevention approaches for this population are limited. A mixed methods pilot randomised controlled trial (N = 29) of the evidence-based Resourceful Adolescent Program-Autism Spectrum Disorder (RAP-A-ASD) designed to prevent depression was conducted in schools with adolescents with ASD in years 6 and 7. Quantitative results showed significant intervention effects on parent reports of adolescent coping self-efficacy (maintained at 6 month follow-up) but no effect on depressive symptoms or mental health. Qualitative outcomes reflected perceived improvements from the intervention for adolescents' coping self-efficacy, self-confidence, social skills, and affect regulation. Converging results remain encouraging given this population's difficulties coping with adversity, managing emotions and interacting socially which strongly influence developmental outcomes.
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15
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Arora PG, Baker CN, Marchette LK, Stark KD. Components Analyses of a School-Based Cognitive Behavioral Treatment for Youth Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 48:S180-S193. [PMID: 28278602 DOI: 10.1080/15374416.2017.1280800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current study sought to build upon research on cognitive behavioral therapy (CBT) as the first-line treatment for depressed youth by investigating the effects of the various components of a CBT treatment on changes in depressive symptoms in young female participants. Female participants 9-14 years of age (n = 40; M age = 10.58 years) with a diagnosis of a depressive disorder from the CBT-only treatment condition of a larger randomized clinical trial were included in the current study. Participants engaged in a 20-session, 11-week, school-based CBT group intervention (ACTION Treatment; Stark et al., 2006). Depressive symptoms were assessed pre- and posttreatment, and intervention components were coded based on review of audio recordings of treatment sessions. Data were examined using two-level mixed-effects models using hierarchical linear modeling with full maximum likelihood estimation. Results indicated that higher quality behavioral intervention components were associated with greater improvement in posttreatment depression scores, higher quality cognitive intervention components were marginally associated with worsening posttreatment depression scores, and relational intervention components were not associated with depression outcome. Age significantly moderated the relationships between intervention components and depression outcome, with younger female participants benefiting most from higher quality behavioral and relational intervention components. These findings provide preliminary evidence about the differential impact of CBT components on depression treatment outcome for young female participants, with consideration of age as a moderator. This study highlights the importance of continuing to dismantle CBT treatment components for youth depression, as such findings can be used to design more potent, developmentally tailored interventions.
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Affiliation(s)
- Prerna G Arora
- a Department of Psychology , Pace University.,b Division of Child and Adolescent Psychiatry , University of Maryland School of Medicine
| | | | | | - Kevin D Stark
- e Department of Educational Psychology , University of Texas Austin
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16
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Weersing VR, Jeffreys M, Do MCT, Schwartz KTG, Bolano C. Evidence Base Update of Psychosocial Treatments for Child and Adolescent Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:11-43. [PMID: 27870579 DOI: 10.1080/15374416.2016.1220310] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression in youth is prevalent and disabling and tends to presage a chronic and recurrent course of illness and impairment in adulthood. Clinical trial research in youth depression has a 30-year history, and evidence-based treatment reviews appeared in 1998 and 2008. The current review of 42 randomized controlled trials (RCTs) updates these reviews to include RCTs published between 2008 and 2014 (N = 14) and reevaluates previously reviewed literature. Given the growing maturity of the field, this review utilized a stringent set of methodological criteria for trial inclusion, most notable for excluding trials based in subclinical samples of youth that had been included in previous reviews (N = 12) and including well-designed RCTs with null and negative findings (N = 8). Findings from the current review suggest that evidence for child treatments is notably weaker than for adolescent interventions, with no child treatments achieving well-established status and the evidentiary basis of treatments downgraded from previous reports. Cognitive behavioral therapy (CBT) for clinically depressed children appears to be possibly efficacious, with mixed findings across trials. For depressed adolescents, both CBT and interpersonal psychotherapy are well-established interventions, with evidence of efficacy in multiple trials by independent investigative teams. This positive conclusion is tempered by the small size of the interpersonal psychotherapy literature (N = 6) and concern that CBT effects may be attenuated in clinically complicated samples and when compared against active control conditions. Data on predictors, moderators, and mediators are examined and priorities for future research discussed.
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Affiliation(s)
- V Robin Weersing
- a SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology.,b Department of Psychology , San Diego State University
| | - Megan Jeffreys
- a SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - Minh-Chau T Do
- a SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
| | | | - Carl Bolano
- b Department of Psychology , San Diego State University
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17
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Fristad MA, Vesco AT, Young AS, Healy KZ, Nader ES, Gardner W, Seidenfeld AM, Wolfson HL, Arnold LE. Pilot Randomized Controlled Trial of Omega-3 and Individual-Family Psychoeducational Psychotherapy for Children and Adolescents With Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2016; 48:S105-S118. [PMID: 27819485 PMCID: PMC6066443 DOI: 10.1080/15374416.2016.1233500] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The goal of this study is to evaluate feasibility and estimate effect sizes of omega-3 fatty acids (Ω3), individual-family psychoeducational psychotherapy (PEP), their combination, and moderating effects of maternal depression and psychosocial stressors in youth with depression. In a pilot 2 × 2 randomized controlled trial, 72 youth (ages 7-14; 57% Caucasian, 57% male) with major depression, dysthymia, or depression not otherwise specified were randomized to 12 weeks of Ω3, PEP+placebo, Ω3+PEP, or placebo. Ω3 versus placebo was double-masked. Evaluators masked to condition assessed depressive severity at baseline (randomization) and at 2, 4, 6, 9, and 12 weeks using the Children's Depression Rating Scale-Revised. Side effects were either absent or mild. PEP was administered with 74% fidelity. Remission was 77%, Ω3+PEP; 61%, PEP+placebo; 44%, Ω3; 56%, placebo. Intent-to-treat analyses found small to medium effects of combined treatment (d = .29) and Ω3 monotherapy (d = .42), but negligible effect for PEP+placebo (d < .10), all compared to placebo alone. Relative to placebo, youth with fewer social stressors responded better to Ω3 (p = .04), PEP (p = .028), and their combination (p = .035), and those with maternal depression responded better to PEP (p = .020) than did those without maternal depression. Remission rates were favorable compared to other studies of psychotherapy and comparable to an existing randomized controlled trial of Ω3; results warrant further evaluation in a larger sample. Ω3 was well tolerated. Active treatments show significantly more placebo-controlled depression improvement in the context of maternal depression and fewer stressors, suggesting that they may benefit depression with a more endogenous than environmental origin.
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Affiliation(s)
- Mary A Fristad
- a Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | - Anthony T Vesco
- a Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | - Andrea S Young
- a Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | - K Zachary Healy
- a Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | - Elias S Nader
- a Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | - William Gardner
- a Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | - Adina M Seidenfeld
- a Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | - Hannah L Wolfson
- a Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
| | - L Eugene Arnold
- a Department of Psychiatry and Behavioral Health , The Ohio State University Wexner Medical Center
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Devenish B, Berk L, Lewis AJ. The treatment of suicidality in adolescents by psychosocial interventions for depression: A systematic literature review. Aust N Z J Psychiatry 2016; 50:726-40. [PMID: 26896044 DOI: 10.1177/0004867415627374] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Given depression is a significant risk factor for suicidal behaviour, it is possible that interventions for depression may also reduce the risk of suicide in adolescents. The purpose of this literature review is to determine whether psychological interventions aimed to prevent and/or treat depression in adolescents can also reduce suicidality. METHODS We conducted a systematic review of psychological interventions aimed to prevent and/or treat depression in adolescents in which outcomes for suicidality were reported, using five databases: PsycINFO, Embase, Medline, CINAHL and Scopus. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS A total of 35 articles pertaining to 12 treatment trials, two selective prevention trials and two universal prevention trials met inclusion criteria. No studies were identified that used a no-treatment control. In both intervention and active control groups, suicidality decreased over time; however, most structured psychological depression treatment interventions did not outperform pharmaceutical or treatment as usual control groups. Depression prevention studies demonstrated small but statistically significant reductions in suicidality. LIMITATIONS Analysis of study quality suggested that at least 10 of the 16 studies have a high risk of bias. Conclusive comparisons across studies are problematic due to differences in measures, interventions, population differences and control groups used. CONCLUSIONS It is unclear whether psychological treatments are more effective than no treatment since no study has used a no-treatment control group. There is evidence to suggest that Cognitive Behavioural Therapy interventions produce pre-post reductions in suicidality with moderate effect sizes and are at least as efficacious as pharmacotherapy in reducing suicidality; however, it is unclear whether these effects are sustained. There are several trials showing promising evidence for family-based and interpersonal therapies, with large pre-post effect sizes, and further evaluation with improved methodology is required. Depression prevention interventions show promising short-term effects.
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Affiliation(s)
- Bethany Devenish
- Faculty of Health, School of Psychology, Deakin University, Burwood, Australia
| | - Lesley Berk
- Faculty of Health, School of Psychology, Deakin University, Burwood, Australia Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, Deakin University, Burwood, Australia
| | - Andrew J Lewis
- Faculty of Health, School of Psychology, Deakin University, Burwood, Australia School of Psychology and Exercise Science, Murdoch University, Murdoch WA, Australia
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Robinson J, Hetrick S, Cox G, Bendall S, Yung A, Pirkis J. The safety and acceptability of delivering an online intervention to secondary students at risk of suicide: findings from a pilot study. Early Interv Psychiatry 2015; 9:498-506. [PMID: 24684927 DOI: 10.1111/eip.12136] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 02/05/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Suicide-related behaviour is a major problem among adolescents. Yet relatively few studies have tested the efficacy, acceptability and safety of interventions for this population. We developed and pilot tested an online intervention for at-risk school students, which has led to reduced suicidal ideation, hopelessness and depressive symptoms. The aims of this study were to examine the safety and acceptability of the programme, and to determine which components were found to be most helpful and enjoyable. METHODS This pilot study employed a pre-test/post-test design, with an 8-week intervention phase. Participants were assessed immediately before, and immediately after the intervention. Participants were also asked to complete a weekly questionnaire immediately after the intervention, and again 2 days later assessing suicidal ideation and distress. RESULTS Twenty-one young people completed the intervention. Overall, the intervention did not lead to increases in suicidal ideation or distress. Participants reported enjoying the programme, in particular watching the video diaries and completing the activities, and said they would recommend the programme to a friend. Overall, the cognitive components of the programme were found to be most helpful. CONCLUSIONS Overall, the programme appeared to be a safe and acceptable intervention for at-risk adolescents. This was a small, pilot study so we need to interpret the results with caution. However, the findings are promising and suggest that young people at risk of suicide can safely be included in trials as long as adequate safety procedures are in place. The programme is now being tested in a randomized controlled trial.
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Affiliation(s)
- Jo Robinson
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Hetrick
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Georgina Cox
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Bendall
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Alison Yung
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.,Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Jane Pirkis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Ly KH, Topooco N, Cederlund H, Wallin A, Bergström J, Molander O, Carlbring P, Andersson G. Smartphone-Supported versus Full Behavioural Activation for Depression: A Randomised Controlled Trial. PLoS One 2015; 10:e0126559. [PMID: 26010890 PMCID: PMC4444307 DOI: 10.1371/journal.pone.0126559] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 04/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is need for more cost and time effective treatments for depression. This is the first randomised controlled trial in which a blended treatment--including four face-to-face sessions and a smartphone application--was compared against a full behavioural treatment. Hence, the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression. METHODS This was a randomised controlled non-inferiority trial (NCT01819025) comparing a blended treatment (n=46) against a full ten-session treatment (n=47) for people suffering from major depression. Primary outcome measure was the BDI-II, that was administered at pre- and post-treatment, as well as six months after the treatment. RESULTS Results showed significant improvements in both groups across time on the primary outcome measure (within-group Cohen's d=1.35; CI [-0.82, 3.52] to d=1.47; CI [-0.41, 3.35]; between group d=-0.13 CI [-2.37, 2.09] and d=-0.10 CI [-2.53, 2.33]). At the same time, the blended treatment reduced the therapist time with an average of 47%. CONCLUSIONS We could not establish whether the blended treatment was non-inferior to a full BA treatment. Nevertheless, this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone application as add-on. More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression. TRIAL REGISTRATION Cognitive Behavioral Therapy Treatment of Depression With Smartphone Support NCT01819025.
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Affiliation(s)
- Kien Hoa Ly
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hanna Cederlund
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Anna Wallin
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Jan Bergström
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
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21
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Hetrick SE, Cox GR, Fisher CA, Bhar SS, Rice SM, Davey CG, Parker AG. Back to basics: could behavioural therapy be a good treatment option for youth depression? A critical review. Early Interv Psychiatry 2015; 9:93-9. [PMID: 24698212 DOI: 10.1111/eip.12142] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 02/28/2014] [Indexed: 12/19/2022]
Abstract
AIM Recent findings from systematic reviews and primary research studies have shown more modest effects of cognitive behavioural therapy (CBT) for youth depression than previously shown, highlighting the need to further enhance the effectiveness of this intervention, or components of this intervention. Therefore, the aim of this review is to summarize the work that has been done to identify the different components of CBT and their varying effectiveness for young people with depression. METHODS Narrative overview of English language reviews/meta-analyses and primary intervention studies retrieved from searches of computerized databases as well as ancestry searches. RESULTS Reviews of intervention studies of adults as well as young people with depression have shown that behavioural approaches are equally as effective as cognitive approaches in reducing depression symptoms. Post-hoc analyses of large studies in youth depression have also shown that behavioural approaches might be more suitable for young people. CONCLUSIONS Behaviourally based approaches appear promising in treating youth depression; however, further research is required. This research will represent an essential step towards refining interventions for youth depression, and enabling interventions to be targeted to particular subgroups, to optimize their effectiveness.
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Affiliation(s)
- Sarah E Hetrick
- Orygen Youth Health Research Centre and Headspace Centre of Excellence, Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Shelleby EC, Kolko DJ. Predictors, Moderators, and Treatment Parameters of Community and Clinic-Based Treatment for Child Disruptive Behavior Disorders. JOURNAL OF CHILD AND FAMILY STUDIES 2015; 24:734-748. [PMID: 25750506 PMCID: PMC4349495 DOI: 10.1007/s10826-013-9884-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study examines predictors, moderators, and treatment parameters associated with two key child outcomes in a recent clinical trial comparing the effects of a modular treatment that was applied by study clinicians in the community (COMM) or a clinic (CLINIC) for children with oppositional defiant disorder (ODD) or conduct disorder (CD). Based on a literature review, moderator and predictor variables across child, parent, and family domains were examined in relation to changes in parental ratings of the severity of externalizing behavior problems or the number of ODD and CD symptoms endorsed on psychiatric interview at pretreatment, posttreatment, and 36-month posttreatment follow-up. In addition, associations between parameters of treatment (e.g., hours of child, parent, and parent-child treatment received, treatment completion, referral for additional services at discharge) and child outcomes were explored. Path models identified few moderators (e.g., level of child impairment, attention deficit hyperactivity disorder diagnosis, level of family conflict) and several predictors (child trauma history, family income, parental employment, parental depression) of treatment response. Treatment response was also related to a few treatment parameters (e.g., hours of child and parent treatment received, treatment completion, referral for additional services at discharge). We discuss the implications of these findings for maximizing the benefits of modular treatment by optimizing or personalizing intervention approaches for children with behavior disorders.
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Affiliation(s)
- Elizabeth C. Shelleby
- Department of Psychology, University of Pittsburgh, 4425 Sennott Square, 210 S. Bouquet St., Pittsburgh, PA 15260, USA
| | - David J. Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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McCauley E, Gudmundsen G, Schloredt K, Martell C, Rhew I, Hubley S, Dimidjian S. The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 45:291-304. [PMID: 25602170 DOI: 10.1080/15374416.2014.979933] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation (BA) based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression. The urban sample was 64% female, predominantly Non-Hispanic White (67%), and had an average age of 14.9 years. Measures of depression, global functioning, activation, and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at preintervention and end of intervention. Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pretreatment to end of treatment in depression, global functioning, and activation and avoidance. There were no significant differences across treatment conditions. These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.
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Affiliation(s)
| | | | - Kelly Schloredt
- a Seattle Children's Research Institute and University of Washington
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24
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Cox GR, Callahan P, Churchill R, Hunot V, Merry SN, Parker AG, Hetrick SE. Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane Database Syst Rev 2014; 2014:CD008324. [PMID: 25433518 PMCID: PMC8556660 DOI: 10.1002/14651858.cd008324.pub3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Depressive disorders are common in children and adolescents and, if left untreated, are likely to recur in adulthood. Depression is highly debilitating, affecting psychosocial, family and academic functioning. OBJECTIVES To evaluate the effectiveness of psychological therapies and antidepressant medication, alone and in combination, for the treatment of depressive disorder in children and adolescents. We have examined clinical outcomes including remission, clinician and self reported depression measures, and suicide-related outcomes. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to 11 June 2014. The register contains reports of relevant randomised controlled trials (RCTs) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). SELECTION CRITERIA RCTs were eligible for inclusion if they compared i) any psychological therapy with any antidepressant medication, or ii) a combination of psychological therapy and antidepressant medication with a psychological therapy alone, or an antidepressant medication alone, or iii) a combination of psychological therapy and antidepressant medication with a placebo or'treatment as usual', or (iv) a combination of psychological therapy and antidepressant medication with a psychological therapy or antidepressant medication plus a placebo.We included studies if they involved participants aged between 6 and 18 years, diagnosed by a clinician as having Major Depressive Disorder (MDD) based on Diagnostic and Statistical Manual (DSM) or International Classification of Diseases (ICD) criteria. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the quality of the studies. We applied a random-effects meta-analysis, using the odds ratio (OR) to describe dichotomous outcomes, mean difference (MD) to describe continuous outcomes when the same measures were used, and standard mean difference (SMD) when outcomes were measured on different scales. MAIN RESULTS We included eleven studies, involving 1307 participants in this review. We also identified one ongoing study, and two additional ongoing studies that may be eligible for inclusion. Studies recruited participants with different severities of disorder and with a variety of comorbid disorders, including anxiety and substance use disorder, therefore limiting the comparability of the results. Regarding the risk of bias in studies, just under half the studies had adequate allocation concealment (there was insufficient information to determine allocation concealment in the remainder), outcome assessors were blind to the participants' intervention in six studies, and in general, studies reported on incomplete data analysis methods, mainly using intention-to-treat (ITT) analyses. For the majority of outcomes there were no statistically significant differences between the interventions compared. There was limited evidence (based on two studies involving 220 participants) that antidepressant medication was more effective than psychotherapy on measures of clinician defined remission immediately post-intervention (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.27 to 0.98), with 67.8% of participants in the medication group and 53.7% in the psychotherapy group rated as being in remission. There was limited evidence (based on three studies involving 378 participants) that combination therapy was more effective than antidepressant medication alone in achieving higher remission from a depressive episode immediately post-intervention (OR 1.56, 95% CI 0.98 to 2.47), with 65.9% of participants treated with combination therapy and 57.8% of participants treated with medication, rated as being in remission. There was no evidence to suggest that combination therapy was more effective than psychological therapy alone, based on clinician rated remission immediately post-intervention (OR 1.82, 95% CI 0.38 to 8.68).Suicide-related Serious Adverse Events (SAEs) were reported in various ways across studies and could not be combined in meta-analyses. However, some trials measured suicidal ideation using standardised assessment tools suitable for meta-analysis. In one study involving 188 participants, rates of suicidal ideation were significantly higher in the antidepressant medication group (18.6%) compared with the psychological therapy group (5.4%) (OR 0.26, 95% CI 0.09 to 0.72) and this effect appeared to remain at six to nine months (OR 0.26, 95% CI 0.07 to 0.98), with 13.6% of participants in the medication group and 3.9% of participants in the psychological therapy group reporting suicidal ideation. It was unclear what the effect of combination therapy was compared with either antidepressant medication alone or psychological therapy alone on rates of suicidal ideation. The impact of any of the assigned treatment packages on drop out was also mostly unclear across the various comparisons in the review.Limited data and conflicting results based on other outcome measures make it difficult to draw conclusions regarding the effectiveness of any specific intervention based on these outcomes. AUTHORS' CONCLUSIONS There is very limited evidence upon which to base conclusions about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these interventions. On the basis of the available evidence, the effectiveness of these interventions for treating depressive disorders in children and adolescents cannot be established. Further appropriately powered RCTs are required.
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Affiliation(s)
- Georgina R Cox
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Patch Callahan
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Rachel Churchill
- University of BristolCentre for Academic Mental Health, School of Social and Community MedicineOakfield HouseOakfield GroveBristolUKBS8 2BN
| | - Vivien Hunot
- University of BristolCentre for Academic Mental Health, School of Social and Community MedicineOakfield HouseOakfield GroveBristolUKBS8 2BN
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicinePrivate Bag 92019AucklandNew Zealand
| | - Alexandra G Parker
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Sarah E Hetrick
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
- University of Melbourneheadspace Centre of Excellence, Centre for Youth Mental HealthMelbourneVictoriaAustralia
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Silk JS, Siegle GJ, Lee KH, Nelson EE, Stroud LR, Dahl RE. Increased neural response to peer rejection associated with adolescent depression and pubertal development. Soc Cogn Affect Neurosci 2014; 9:1798-807. [PMID: 24273075 PMCID: PMC4221220 DOI: 10.1093/scan/nst175] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 10/22/2013] [Accepted: 11/17/2013] [Indexed: 12/31/2022] Open
Abstract
Sensitivity to social evaluation has been proposed as a potential marker or risk factor for depression, and has also been theorized to increase with pubertal maturation. This study utilized an ecologically valid paradigm to test the hypothesis that adolescents with major depressive disorder (MDD) would show altered reactivity to peer rejection and acceptance relative to healthy controls in a network of ventral brain regions implicated in affective processing of social information. A total of 48 adolescents (ages 11-17), including 21 with a current diagnosis of MDD and 27 age- and gender-matched controls, received rigged acceptance and rejection feedback from fictitious peers during a simulated online peer interaction during functional neuroimaging. MDD youth showed increased activation to rejection relative to controls in the bilateral amygdala, subgenual anterior cingulate, left anterior insula and left nucleus accumbens. MDD and healthy youth did not differ in response to acceptance. Youth more advanced in pubertal maturation also showed increased reactivity to rejection in the bilateral amygdala/parahippocampal gyrus and the caudate/subgenual anterior cingulate, and these effects remained significant when controlling for chronological age. Findings suggest that increased reactivity to peer rejection is a normative developmental process associated with pubertal development, but is particularly enhanced among youth with depression.
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Affiliation(s)
- Jennifer S Silk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA, Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20895, USA, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA, and School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA, Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20895, USA, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA, and School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA, Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20895, USA, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA, and School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA, Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20895, USA, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA, and School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Kyung Hwa Lee
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA, Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20895, USA, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA, and School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Eric E Nelson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA, Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20895, USA, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA, and School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Laura R Stroud
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA, Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20895, USA, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA, and School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Ronald E Dahl
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA, Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA, Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20895, USA, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA, and School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA
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26
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Dubicka B, Brent D. Combined Therapy in Adolescent Depression. Int J Cogn Ther 2014. [DOI: 10.1521/ijct.2014.7.2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Curry JF. Future Directions in Research on Psychotherapy for Adolescent Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 43:510-26. [DOI: 10.1080/15374416.2014.904233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Development and Evolution of Cognitive Behavior Therapy for Depressed Adolescents. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2014. [DOI: 10.1007/s10942-014-0180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dietz LJ, Marshal MP, Burton CM, Bridge JA, Birmaher B, Kolko D, Duffy JN, Brent DA. Social problem solving among depressed adolescents is enhanced by structured psychotherapies. J Consult Clin Psychol 2014; 82:202-11. [PMID: 24491077 DOI: 10.1037/a0035718] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Changes in adolescent interpersonal behavior before and after an acute course of psychotherapy were investigated as outcomes and mediators of remission status in a previously described treatment study of depressed adolescents. Maternal depressive symptoms were examined as moderators of the association between psychotherapy condition and changes in adolescents' interpersonal behavior. METHOD Adolescents (n = 63, mean age = 15.6 years, 77.8% female, 84.1% White) engaged in videotaped interactions with their mothers before randomization to cognitive behavior therapy (CBT), systemic behavior family therapy (SBFT), or nondirective supportive therapy (NST) and after 12-16 weeks of treatment. Adolescent involvement, problem solving, and dyadic conflict were examined. RESULTS Improvements in adolescent problem solving were significantly associated with CBT and SBFT. Maternal depressive symptoms moderated the effect of CBT, but not SBFT, on adolescents' problem solving; adolescents experienced increases in problem solving only when their mothers had low or moderate levels of depressive symptoms. Improvements in adolescents' problem solving were associated with higher rates of remission across treatment conditions, but there were no significant indirect effects of SBFT on remission status through problem solving. Exploratory analyses revealed a significant indirect effect of CBT on remission status through changes in adolescent problem solving, but only when maternal depressive symptoms at study entry were low. CONCLUSIONS Findings provide preliminary support for problem solving as an active treatment component of structured psychotherapies for depressed adolescents and suggest one pathway by which maternal depression may disrupt treatment efficacy for depressed adolescents treated with CBT.
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Affiliation(s)
- Laura J Dietz
- Western Psychiatric Institute and Clinic, University of Pittsburgh
| | | | - Chad M Burton
- Western Psychiatric Institute and Clinic, University of Pittsburgh
| | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh
| | - David Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh
| | | | - David A Brent
- Western Psychiatric Institute and Clinic, University of Pittsburgh
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Brief, personality-targeted, teacher-delivered CBT interventions reduce depression, anxiety and conduct disorder symptoms in high-risk adolescents. EVIDENCE-BASED MENTAL HEALTH 2014; 17:5. [DOI: 10.1136/eb-2013-101577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Asarnow JR, Miranda J. Improving care for depression and suicide risk in adolescents: innovative strategies for bringing treatments to community settings. Annu Rev Clin Psychol 2014; 10:275-303. [PMID: 24437432 PMCID: PMC4295487 DOI: 10.1146/annurev-clinpsy-032813-153742] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article reviews the literature on interventions and services for depression and suicide prevention among adolescents, with the goals of placing this science within the context of currently changing health care environments and highlighting innovative models for improving health and mental health. We examine the challenges and opportunities offered by new initiatives and legislation designed to transform the US health and mental health care systems; summarize knowledge regarding the treatment of depression and suicidality/self-harm in adolescents; and describe innovative models for partnering with health systems and communities. This review demonstrates that treatment models and service delivery strategies are currently available for increasing evidence-based care, particularly for depression, and concludes with recommendations for future research and quality improvement initiatives aimed at inspiring additional efforts to put science to work, bridge science and community practice, and develop strategies for partnering with communities to improve care, mental health, and well-being among adolescents.
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Affiliation(s)
- Joan Rosenbaum Asarnow
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90095; ,
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Lewandowski RE, Acri MC, Hoagwood KE, Olfson M, Clarke G, Gardner W, Scholle SH, Byron S, Kelleher K, Pincus HA, Frank S, Horwitz SM. Evidence for the management of adolescent depression. Pediatrics 2013; 132:e996-e1009. [PMID: 24043282 PMCID: PMC4074649 DOI: 10.1542/peds.2013-0600] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 12/28/2022] Open
Abstract
Adolescent depression is a prevalent and disabling condition resulting in emotional suffering and social and educational dysfunction. Care for adolescent depression is suboptimal and could be improved through the development and use of quality indicators (QIs). This article reports on the development of a care pathway and QIs for the primary and specialty care management of adolescent depression from case identification through symptom remission. It presents evidence from a review of adolescent clinical practice guidelines and research literature to support QIs at critical nodes in the pathway, and describes implications for practice based on existing evidence. Barriers to measure development are identified, including gaps in empirical evidence, and a research agenda is suggested.
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Affiliation(s)
- R Eric Lewandowski
- MSc, Department of Child and Adolescent Psychiatry, NYU School of Medicine, 1 Park Ave, New York, NY 10016.
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Impact of treatments for depression on comorbid anxiety, attentional, and behavioral symptoms in adolescents with selective serotonin reuptake inhibitor-resistant depression. J Am Acad Child Adolesc Psychiatry 2013; 52:482-92. [PMID: 23622849 PMCID: PMC3756470 DOI: 10.1016/j.jaac.2013.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 02/26/2013] [Accepted: 02/28/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the relative efficacy of antidepressant medication, alone and in combination with cognitive behavioral therapy (CBT), on comorbid symptoms of anxiety, attention, and disruptive behavior disorders in participants in the Treatment of Resistant Depression in Adolescents (TORDIA) trial. METHOD Adolescents with selective serotonin reuptake inhibitor (SSRI)-resistant depression (N = 334) were randomly assigned to a medication switch alone (to another SSRI or to venlafaxine) or to a medication switch plus CBT. Anxiety, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorder (DBD) symptoms were assessed by psychiatric interview and self-report at regular intervals between baseline and 24 weeks. The differential effects of medication and of CBT, and the impact of remission on the course of comorbid symptoms and diagnoses, were assessed using generalized linear mixed models. RESULTS Remission was associated with a greater reduction in scalar measures of anxiety, ADHD, and DBDs, and a greater decrease in the rate of diagnosed anxiety disorders. The correlations between the changes in symptoms of depression on the CDRS-R and anxiety, ADHD, and oppositional symptoms were modest, ranging from r = 0.12 to r = 0.28. There were no significant differential treatment effects on diagnoses, or corresponding symptoms. CONCLUSION The achievement of remission had a beneficial effect on anxiety, ADHD, and DBD symptoms, regardless of the type of treatment received. There were no differential effects of medication or CBT on outcome, except for a nonsignificant trend that those adolescents treated with SSRIs showed a greater decrease in rates of comorbid DBDs relative to those treated with venlafaxine. Clinical trial registration information-Treatment of SSRI-Resistant Depression In Adolescents (TORDIA); http://clinicaltrials.gov/; NCT00018902.
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Abstract
OBJECTIVE To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review. METHOD Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications. RESULTS Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment. CONCLUSION Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal.
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Affiliation(s)
- L Lampe
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia.
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35
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Stress generation: Future directions and clinical implications. Clin Psychol Rev 2013; 33:406-16. [DOI: 10.1016/j.cpr.2013.01.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 01/12/2013] [Accepted: 01/14/2013] [Indexed: 11/19/2022]
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Bru L, Solholm R, Idsoe T. Participants’ experiences of an early cognitive behavioral intervention for adolescents with symptoms of depression. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2013. [DOI: 10.1080/13632752.2012.675138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cox GR, Callahan P, Churchill R, Hunot V, Merry SN, Parker AG, Hetrick SE. Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane Database Syst Rev 2012; 11:CD008324. [PMID: 23152255 DOI: 10.1002/14651858.cd008324.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Depressive disorders are common in children and adolescents and, if left untreated, are likely to recur in adulthood. Depression is highly debilitating, affecting psychosocial, family and academic functioning. OBJECTIVES To evaluate the effectiveness of psychological therapies and antidepressant medication, alone and in combination, for the treatment of depressive disorder in children and adolescents. We have examined clinical outcomes including remission, clinician and self reported depression measures, and suicide-related outcomes. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to 11 November 2011. This register contains reports of relevant randomised controlled trials (RCTs) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). SELECTION CRITERIA RCTs were eligible for inclusion if they compared i) any psychological therapy with any antidepressant medication, or ii) a combination of psychological therapy and antidepressant medication with a psychological therapy alone, or an antidepressant medication alone, or iii) a combination of psychological therapy and antidepressant medication with a placebo or 'treatment as usual', or (iv) a combination of psychological therapy and antidepressant medication with a psychological therapy or antidepressant medication plus a placebo.We included studies if they involved participants aged between 6 and 18 years, diagnosed by a clinician as having Major Depressive Disorder (MDD) based on Diagnostic and Statistical Manual (DSM) or International Classification of Diseases (ICD) criteria. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the quality of the studies. We applied a random-effects meta-analysis, using the odds ratio (OR) to describe dichotomous outcomes, mean difference (MD) to describe continuous outcomes when the same measures were used, and standard mean difference (SMD) when outcomes were measured on different scales. MAIN RESULTS We included ten studies, involving 1235 participants in this review. Studies recruited participants with different severities of disorder and with a variety of comorbid disorders, including anxiety and substance use disorder, therefore limiting the comparability of the results. Regarding the risk of bias in studies, half the studies had adequate allocation concealment (there was insufficient information to determine allocation concealment in the remainder), outcome assessors were blind to the participants' intervention in six studies, and in general, studies reported on incomplete data analysis methods, mainly using intention-to-treat (ITT) analyses. For the majority of outcomes there were no statistically significant differences between the interventions compared. There was limited evidence (based on two studies involving 220 participants) that antidepressant medication was more effective than psychotherapy on measures of clinician defined remission immediately post-intervention (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.27 to 0.98), with 67.8% of participants in the medication group and 53.7% in the psychotherapy group rated as being in remission. There was limited evidence (based on three studies involving 378 participants) that combination therapy was more effective than antidepressant medication alone in achieving higher remission from a depressive episode immediately post-intervention (OR 1.56, 95% CI 0.98 to 2.47), with 65.9% of participants treated with combination therapy and 57.8% of participants treated with medication, rated as being in remission. There was no evidence to suggest that combination therapy was more effective than psychological therapy alone, based on clinician rated remission immediately post-intervention (OR 1.82, 95% CI 0.38 to 8.68).Suicide-related Serious Adverse Events (SAEs) were reported in various ways across studies and could not be combined in meta-analyses. However suicidal ideation specifically was generally measured and reported using standardised assessment tools suitable for meta-analysis. In one study involving 188 participants, rates of suicidal ideation were significantly higher in the antidepressant medication group (18.6%) compared with the psychological therapy group (5.4%) (OR 0.26, 95% CI 0.09 to 0.72) and this effect appeared to remain at six to nine months (OR 1.27, 95% CI 0.68 to 2.36), with 13.6% of participants in the medication group and 3.9% of participants in the psychological therapy group reporting suicidal ideation. It was unclear what the effect of combination therapy was compared with either antidepressant medication alone or psychological therapy alone on rates of suicidal ideation. The impact of any of the assigned treatment packages on drop out was also mostly unclear across the various comparisons in the review.Limited data and conflicting results based on other outcome measures make it difficult to draw conclusions regarding the effectiveness of any specific intervention based on these outcomes. AUTHORS' CONCLUSIONS There is very limited evidence upon which to base conclusions about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these interventions. On the basis of the available evidence, the effectiveness of these interventions for treating depressive disorders in children and adolescents cannot be established. Further appropriately powered RCTs are required.
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Affiliation(s)
- Georgina R Cox
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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Abstract
Youth who have mental health issues are more likely than their peers to seek primary care services. The primary care setting is an appropriate venue for screening and identifying pediatric depression. Additionally, nurse practitioners can provide initial management or referral to psychiatric mental health professionals for evidence-based treatments.
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McMakin DL, Olino TM, Porta G, Dietz LJ, Emslie G, Clarke G, Wagner KD, Asarnow JR, Ryan ND, Birmaher B, Shamseddeen W, Mayes T, Kennard B, Spirito A, Keller M, Lynch FL, Dickerson JF, Brent DA. Anhedonia predicts poorer recovery among youth with selective serotonin reuptake inhibitor treatment-resistant depression. J Am Acad Child Adolesc Psychiatry 2012; 51:404-11. [PMID: 22449646 PMCID: PMC3536476 DOI: 10.1016/j.jaac.2012.01.011] [Citation(s) in RCA: 294] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 01/13/2012] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To identify symptom dimensions of depression that predict recovery among selective serotonin reuptake inhibitor (SSRI) treatment-resistant adolescents undergoing second-step treatment. METHOD The Treatment of Resistant Depression in Adolescents (TORDIA) trial included 334 SSRI treatment-resistant youth randomized to a medication switch, or a medication switch plus CBT. This study examined five established symptom dimensions (Child Depression Rating Scale-Revised) at baseline as they predicted recovery over 24 weeks of acute and continuation treatment. The two indices of recovery that were evaluated were time to remission and number of depression-free days. RESULTS Multivariate analyses examining all five depression symptom dimensions simultaneously indicated that anhedonia was the only dimension to predict a longer time to remission, and also the only dimension to predict fewer depression-free days. In addition, when anhedonia and CDRS-total score were evaluated simultaneously, anhedonia continued to uniquely predict longer time to remission and fewer depression-free days. CONCLUSIONS Anhedonia may represent an important negative prognostic indicator among treatment-resistant depressed adolescents. Further research is needed to elucidate neurobehavioral underpinnings of anhedonia, and to test treatments that target anhedonia in the context of overall treatment of depression.
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Tompson MC, Boger KD, Asarnow JR. Enhancing the developmental appropriateness of treatment for depression in youth: integrating the family in treatment. Child Adolesc Psychiatr Clin N Am 2012; 21:345-84. [PMID: 22537731 PMCID: PMC4808580 DOI: 10.1016/j.chc.2012.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Treatment models for youth depression that emphasize interpersonal functioning, particularly family relationships, may be particularly promising. This article first reviews the current state of knowledge on the efficacy of psychosocial treatments for depression in youth, with an emphasis on family involvement in treatment. It then discusses developmental factors that may impact the applicability and structure of family-focused treatment models for preadolescent and adolescent youth. Finally, two family-based treatment models that are currently being evaluated in randomized clinical trials are described: one focusing on preadolescent depressed youth and the other on adolescents who have made a recent suicide attempt.
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Affiliation(s)
- Martha C Tompson
- Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02215, USA.
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Washburn JJ, Richardt SL, Styer DM, Gebhardt M, Juzwin KR, Yourek A, Aldridge D. Psychotherapeutic approaches to non-suicidal self-injury in adolescents. Child Adolesc Psychiatry Ment Health 2012; 6:14. [PMID: 22463499 PMCID: PMC3782878 DOI: 10.1186/1753-2000-6-14] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 03/30/2012] [Indexed: 11/10/2022] Open
Abstract
Non-suicidal self-injury (NSSI) among adolescents is gaining increasing attention in both clinical and scientific arenas. The lifetime prevalence of NSSI is estimated to vary between 7.5% to 8% for preadolescents, increasing to between 12% and 23% for adolescents. Despite the prevalence and the increasing interest in NSSI, few psychotherapeutic treatments have been designed specifically for NSSI, and no treatments have been evaluated specifically for the treatment of NSSI among adolescents. Consequently, child and adolescent clinicians are left with little evidence-based guidance for treating this challenging population. To provide some guidance, evaluations of treatments for adults with NSSI and for adolescents with related conditions, such as deliberate self-harm and borderline personality disorder, are reviewed. Clinical guidelines and resources are also discussed to assist with the gaps in the knowledge base for treatment of NSSI among adolescents.
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Affiliation(s)
- Jason J Washburn
- Alexian Brothers Behavioral Health Hospital, Center for Evidence-Based Practice, 1650 Moon Lake Blvd, Hoffman Estates, IL 60169, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Sarah L Richardt
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Denise M Styer
- Alexian Brothers Behavioral Health Hospital, Center for Evidence-Based Practice, 1650 Moon Lake Blvd, Hoffman Estates, IL 60169, USA
| | - Michelle Gebhardt
- Alexian Brothers Behavioral Health Hospital, Center for Evidence-Based Practice, 1650 Moon Lake Blvd, Hoffman Estates, IL 60169, USA
| | - K R Juzwin
- Alexian Brothers Behavioral Health Hospital, Center for Evidence-Based Practice, 1650 Moon Lake Blvd, Hoffman Estates, IL 60169, USA
- College of Psychology and Behavioral Sciences, Argosy University, 999 N. Plaza Drive, Schaumburg, IL, 60173, USA
| | - Adrienne Yourek
- Alexian Brothers Behavioral Health Hospital, Center for Evidence-Based Practice, 1650 Moon Lake Blvd, Hoffman Estates, IL 60169, USA
| | - Delia Aldridge
- Alexian Brothers Behavioral Health Hospital, Center for Evidence-Based Practice, 1650 Moon Lake Blvd, Hoffman Estates, IL 60169, USA
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Wagner KD, Asarnow JR, Vitiello B, Clarke G, Keller M, Emslie GJ, Ryan N, Porta G, Iyengar S, Ritz L, Zelanzny J, Onorato M, Brent D. Out of the black box: treatment of resistant depression in adolescents and the antidepressant controversy. J Child Adolesc Psychopharmacol 2012; 22:5-10. [PMID: 22251022 PMCID: PMC3281287 DOI: 10.1089/cap.2011.0045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the effects of the pediatric antidepressant controversy on the Treatment of Serotonin-Selective Reuptake Inhibitor (SSRI) Resistant Depression in Adolescents (TORDIA) trial. METHOD Adolescents, ages 12-18 years, with SSRI resistant depression were randomized to one of four treatments for a 12 week trial: Switch to different SSRI, switch to an alternate antidepressant (venlafaxine), switch to an alternate SSRI plus cognitive behavior therapy (CBT), or switch to venlafaxine plus CBT. RESULTS The health advisories and "black box" warnings regarding suicidality and antidepressants in adolescents occurred during the course of the TORDIA trial. Revisions to the protocol, multiple-consent form changes, and re-consenting of patients were necessary. Recruitment of participants was adversely affected. CONCLUSION Despite a cascade of unforeseen events that delayed the completion of the study, the TORDIA trial resulted in clinically important information about treatment-resistant depression in adolescents.
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Affiliation(s)
- Karen Dineen Wagner
- Division of Child and Adolescent Psychiatry, The University of Texas Medical Branch, Galveston, Texas 77555, USA.
| | - Joan Rosenbaum Asarnow
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Benedetto Vitiello
- Child and Adolescent Treatment and Preventative Intervention Research Branch, NIMH, Bethesda, Maryland
| | - Gregory Clarke
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Martin Keller
- Department of Psychiatry, Brown University, Providence, Rhode Island
| | - Graham J. Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Neal Ryan
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Giovanna Porta
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Louise Ritz
- Department of Research, National Institute of Mental Health, Bethesda, Maryland. Currently affiliated with National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland
| | - Jamie Zelanzny
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew Onorato
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, Ohio.,Department of Psychiatry, The Ohio State University, Columbus, Ohio
| | - David Brent
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
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Simons AD, Marti CN, Rohde P, Lewis CC, Curry J, March J. Does Homework “Matter” in Cognitive Behavioral Therapy for Adolescent Depression? J Cogn Psychother 2012. [DOI: 10.1891/0889-8391.26.4.390] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: Examine the degree to which homework completion is associated with various indices of clinical improvement in adolescents with depression treated with cognitive behavioral therapy (CBT) either as a monotherapy and in combination with antidepressant medication. Method: This study used data from the Treatment of Adolescents with Depression Study (TADS), which compared the efficacy of CBT, fluoxetine (FLX), the combination of CBT and FLX (COMB), and a pill placebo (PBO; TADS Team, 2003, 2004, 2005). Current analyses included only TADS participants in the CBT (n = 111) or COMB (n = 107) conditions. Analyses focused on the relations between partial and full homework completion and a dichotomized measure of clinical response, evaluator and self-report ratings of depressive symptoms, hopelessness, and suicidality. Results: Homework completion significantly predicted clinical improvement, decrease in self-reported hopelessness, suicidality, and depression—but not in evaluator-rated depressive symptoms—in adolescents treated with CBT only. These relationships were almost completely absent in the COMB condition. The only significant COMB finding was that partially completed homework was related to decrease in hopelessness over time. Conclusions: These findings suggest that the ability of therapists and clients to collaboratively develop and complete between-session assignments is associated with response to CBT, self-report of severity of depressive symptoms, hopelessness, and suicidality and may be integral to optimizing the effects of CBT when delivered as a monotherapy.
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Abstract
PURPOSE OF REVIEW Adolescent depression is a chronic, pervasive, and disabling problem that is often under-recognized and under-treated. The objective of this article is to review recent (over the past 12-18 months) literature on the management of depression in adolescents, with a particular focus on pharmacological and psychological treatments as well as community and internet-based prevention and treatment programmes. RECENT FINDINGS The tendency for depression in young people to be associated with a number of other disorders and behaviours, including anxiety, suicide, conduct disorder and substance abuse, compounds the complexity of management and can contribute to a negative long-term impact on adult mental health. Results of recent randomized controlled trials have reinforced our understanding that the management of moderate-to-severe depression in adolescents should be assertive and prompt, typically including a combination of psychological and pharmacological interventions. SUMMARY While the development of novel treatments is evolving, there is an urgent need to focus on defining the optimal use of available therapies and tailoring these to individual presentations, as well as upon improving identification of adolescent depressive disorders in the community.
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[How specific is the evidence base for child and adolescent psychotherapy?]. Prax Kinderpsychol Kinderpsychiatr 2011; 60:639-48. [PMID: 22145421 DOI: 10.13109/prkk.2011.60.8.639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence-based psychotherapy (EBP) proposes the fit between a specific treatment, therapist, patient and mental disorder. At the same time, the generalization of psychotherapy research findings is intended. In this conflict between individualized and standardized treatment the search for specific active components of psychotherapy is essential to improve intervention methods as well as training of therapists. Many manualized treatments for children and adolescents are considered evidence-based, proven by its outcome. However, their active ingredients often remain unclear. The following methods to identify necessary active components for successful treatments are described: classical comparative randomized controlled trials, dismantling studies, add-on studies, meta-analyses, and the multiphase optimization strategy. Consequences for the future agenda for child and adolescent psychotherapy research are discussed.
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Schoenwald SK, Garland AF, Southam-Gerow MA, Chorpita BF, Chapman JE. Adherence Measurement in Treatments for Disruptive Behavior Disorders: Pursuing Clear Vision through Varied Lenses. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2011; 18:331-341. [PMID: 22563149 PMCID: PMC3340982 DOI: 10.1111/j.1468-2850.2011.01264.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To extend the reach, transparency, and accountability for the implementation and outcomes of effective treatments in routine care, more clarity is needed about what happens in treatment. We attempt to (a) clarify terminology to describe and measure psychological treatment, and (b) consider what treatment adherence instruments can tell us about what happens in treatment. We reviewed the content of 11 adherence instruments for 14 evidence-based treatments for disruptive behavior problems in youth identified in an ongoing review of adherence measurement methods used in psychosocial treatment studies from 1980 - 2008. Item number, content, and level of detail varied widely. Implications are considered for the definition of effective treatments and design and testing of strategies to measure and monitor their delivery.
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Maalouf FT, Atwi M, Brent DA. Treatment-resistant depression in adolescents: review and updates on clinical management. Depress Anxiety 2011; 28:946-54. [PMID: 21898710 DOI: 10.1002/da.20884] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 07/08/2011] [Accepted: 07/08/2011] [Indexed: 12/23/2022] Open
Abstract
Treatment-resistant depression (TRD) in adolescents is prevalent and impairing. We here review the definition, prevalence, clinical significance, risk factors, and management of TRD in adolescents. Risk factors associated with TRD include characteristics of depression (severity, level of hopelessness, and suicidal ideation), psychiatric and medical comorbidities, environmental factors (family conflict, maternal depression, and history of abuse), and pharmacokinetics and other biomarkers. Management options include review of the adequacy of the initial treatment, re-assessment for the above-noted factors that might predispose to treatment resistance, switching antidepressants, and augmentation with medication or psychotherapy. Other modalities, such as electroconvulsive therapy, vagal nerve stimulation, and repetitive transcranial magnetic stimulation, are also reviewed.
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Affiliation(s)
- Fadi T Maalouf
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
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48
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Abstract
This paper first summarizes the main findings of clinical studies conducted over the past two and a half decades on psychopathology (i.e., psychiatric diagnoses, behavior and emotional problems) in children with new onset and chronic epilepsy both with and without intellectual disability who are treated medically and surgically. Although impaired social relationships are core features of the psychiatric disorders found in pediatric epilepsy, few studies have examined social competence (i.e., social behavior, social adjustment, and social cognition) in these children. There also is a dearth of treatment studies on the frequent psychiatric comorbidities of pediatric epilepsy, attention deficit hyperactivity disorder, anxiety disorders, and depression. Drs. Hamiwka and Jones then describe their current and planned studies on social competence and cognitive behavioral treatment of anxiety disorders, respectively, in these children and how they might mitigate the poor long-term psychiatric and social outcome of pediatric epilepsy.
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Affiliation(s)
- Lorie Hamiwka
- Division of Child Neurology, Ohio State University College of Medicine, Columbus, OH, USA
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49
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Hetrick SE, Cox GR, Merry SN. Treatment-resistant depression in adolescents: is the addition of cognitive behavioral therapy of benefit? Psychol Res Behav Manag 2011; 4:97-112. [PMID: 22114540 PMCID: PMC3218778 DOI: 10.2147/prbm.s13780] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Many young people with major depression fail first-line treatments. Treatment-resistant depression has various definitions in the literature but typically assumes nonresponse to medication. In young people, cognitive behavioral therapy (CBT) is the recommended first-line intervention, thus the definition of treatment resistance should be expanded. Therefore, our aim was to synthesize the existing evidence of any interventions for treatment-resistant depression, broadly defined, in children and adolescents and to investigate the effectiveness of CBT in this context. Methods We used Cochrane Collaboration methodology, with electronic searches of Medline, PsycINFO, Embase, and the Cochrane Depression Anxiety and Neurosis Group trials registers. Only randomized controlled trials were included, and were assessed for risk of bias. Meta- analysis was undertaken where possible and appropriate. Results Of 953 articles retrieved, four trials were eligible for inclusion. For one study, only the trial registration document was available, because the study was never completed. All other studies were well conducted with a low risk of bias, although one study had a high dropout rate. Two studies assessed the effect of adding CBT to medication. While an assertive trial of antidepressants does appear to lead to benefit, when compared with placebo, there was no significant advantage, in either study, or in a meta-analysis of data from these trials, that clearly demonstrated an additional benefit of CBT. The third trial showed little advantage of a tricyclic antidepressant over placebo in the context of an inpatient admission. Conclusion Few randomized controlled trials have investigated interventions for treatment-resistant depression in young people, and results from these show modest benefit from antidepressants with no additional benefit over medication from CBT. Overall, there is a lack of evidence about effective interventions to treat young people who have failed to respond to evidence-based interventions for depression. Research in this area is urgently required.
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Affiliation(s)
- Sarah E Hetrick
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Melbourne, Parkville, Victoria, Australia
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Expanding Behavioral Activation to Depressed Adolescents: Lessons Learned in Treatment Development. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2010.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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