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Zainal NH. Is combined antidepressant medication (ADM) and psychotherapy better than either monotherapy at preventing suicide attempts and other psychiatric serious adverse events for depressed patients? A rare events meta-analysis. Psychol Med 2024; 54:457-472. [PMID: 37964436 DOI: 10.1017/s0033291723003306] [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] [Indexed: 11/16/2023]
Abstract
Antidepressant medication (ADM)-only, psychotherapy-only, and their combination are the first-line treatment options for major depressive disorder (MDD). Previous meta-analyses of randomized controlled trials (RCTs) established that psychotherapy and combined treatment were superior to ADM-only for MDD treatment remission or response. The current meta-analysis extended previous ones by determining the comparative efficacy of ADM-only, psychotherapy-only, and combined treatment on suicide attempts and other serious psychiatric adverse events (i.e. psychiatric emergency department [ED] visit, psychiatric hospitalization, and/or suicide death; SAEs). Peto odds ratios (ORs) and their 95% confidence intervals were computed from the present random-effects meta-analysis. Thirty-four relevant RCTs were included. Psychotherapy-only was stronger than combined treatment (1.9% v. 3.7%; OR 1.96 [1.20-3.20], p = 0.012) and ADM-only (3.0% v. 5.6%; OR 0.45 [0.30-0.67], p = 0.001) in decreasing the likelihood of SAEs in the primary and trim-and-fill sensitivity analyses. Combined treatment was better than ADM-only in reducing the probability of SAEs (6.0% v. 8.7%; OR 0.74 [0.56-0.96], p = 0.029), but this comparative efficacy finding was non-significant in the sensitivity analyses. Subgroup analyses revealed the advantage of psychotherapy-only over combined treatment and ADM-only for reducing SAE risk among children and adolescents and the benefit of combined treatment over ADM-only among adults. Overall, psychotherapy and combined treatment outperformed ADM-only in reducing the likelihood of SAEs, perhaps by conferring strategies to enhance reasons for living. Plausibly, psychotherapy should be prioritized for high-risk youths and combined treatment for high-risk adults with MDD.
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Affiliation(s)
- Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Psychology, National University of Singapore, Singapore
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Wuthrich VM, Zagic D, Dickson SJ, McLellan LF, Chen JTH, Jones MP, Rapee RM. Effectiveness of Psychotherapy for Internalising Symptoms in Children and Adolescents When Delivered in Routine Settings: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2023; 26:824-848. [PMID: 37059918 PMCID: PMC10465434 DOI: 10.1007/s10567-023-00433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/16/2023]
Abstract
This systematic review and meta-analysis aimed to examine the effectiveness of psychological interventions for internalising disorders in youth when delivered in routine settings. Secondary aims were to examine the effectiveness of cognitive behavioural therapy and determine moderators of treatment response. The study was pre-registered (PROSPERO 2020 CRD42020202776). Databases were systematically searched (PsycINFO, Medline, Embase, PubMed, ERIC) in December 2022 and screened according to the PRISMA 2020 statement. Inclusion: School aged participants (4-18 years) with a primary internalising disorder; psychotherapy delivered in a routine setting (e.g. outpatient clinic, school) by setting staff; compared psychotherapy to any control in a randomised controlled trial; reported pre-to-post or pre-to-follow-up comparisons on the primary disorder according to child, parent or independent evaluator report; and was published in English. Risk of bias was assessed using the ROB 2.0 Cochrane tool. Results were synthesised using random effects to pool estimates. Risk ratios were used to analyse dichotomous data and standardised mean differences (SMD) for continuous data. Forty-five studies were included (N = 4901 participants; M = 13 years; range 8-16; SD = 2.5). Nine used waitlist control, 17 treatment as usual, 4 placebo; 15 compared psychotherapy to active control. Psychotherapy was associated with small significant effects pre- to post-treatment compared to non-active controls for anxiety (SMD = - 0.24 to 0.50) and depression (SMD = - 0.19 to 0.34) with effects differing by informant. Psychotherapy led to small significant pre-to-post-benefits in youth internalising disorders in routine settings. Results are limited by reporter type and follow-up.
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Affiliation(s)
- Viviana M Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia.
| | - Dino Zagic
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Sophie J Dickson
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Jessamine T-H Chen
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Michael P Jones
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
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Seegan PL, Miller L, Young AS, Parrish C, Cullen B, Reynolds EK. Enhancing Quality of Care Through Evidence-Based Practice: Training and Supervision Experiences. Am J Psychother 2023; 76:100-106. [PMID: 37026189 DOI: 10.1176/appi.psychotherapy.20220015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Evidence-based practice (EBP) is the preferred approach to treatment in mental health settings because it involves the integration of the best available research, clinical expertise, and patient values to optimize patient outcomes. Training on empirically supported treatments (ESTs) in mental health settings is an important component of EBP, and supervision of therapists' implementation of ESTs is critical for therapists to develop and maintain a strong EBP skill set. This study aimed to evaluate training and supervision histories of therapists in outpatient and inpatient psychiatric care settings as an essential first step in improving patient outcomes. METHODS Electronic surveys were completed by 69 therapists, most of whom had a master's degree, within a psychiatry and behavioral sciences department at an academic institution. Participating therapists were recruited from several outpatient and inpatient mental health settings serving children, adolescents, and adults. RESULTS Although most therapists reported completing some form of EST-related coursework, a majority did not receive any supervision related to implementation of ESTs (51% for cognitive-behavioral therapy cases, 76% for dialectical behavior therapy cases, and 52% for other EST cases) during graduate and postgraduate training. CONCLUSIONS Although research from the past decade has supported the need for improvements in training on ESTs, and especially in supervision, problems related to limited exposure to training and supervision among therapists still exist. These findings have implications for how mental health centers can evaluate staff members' EST training and supervision experiences, training needs, and associated training targets to improve the quality of routine care.
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Affiliation(s)
- Paige L Seegan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (all authors); Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Cullen)
| | - Leslie Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (all authors); Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Cullen)
| | - Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (all authors); Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Cullen)
| | - Carisa Parrish
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (all authors); Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Cullen)
| | - Bernadette Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (all authors); Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Cullen)
| | - Elizabeth K Reynolds
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore (all authors); Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Cullen)
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Serafini G, Costanza A, Aguglia A, Amerio A, Placenti V, Magnani L, Escelsior A, Sher L, Amore M. Overall goal of Cognitive-Behavioral Therapy in Major Psychiatric Disorders and Suicidality: A Narrative Review. Med Clin North Am 2023; 107:143-167. [PMID: 36402496 DOI: 10.1016/j.mcna.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cognitive-behavioral therapy (CBT) is a form of psychological treatment that is based on the underlying assumption that mental disorders and psychological distress are maintained by cognitive factors, that is, that general beliefs about the world, the self, and the future contribute to the maintenance of emotional distress and behavioral problems. The overall goal of CBT is to replace dysfunctional constructs with more flexible and adaptive cognitions. The most relevant cognitive-behavioral techniques in clinical practice are: i. Cognitive Restructuring (also known as the ABCDE method) is indicated to support patients dealing with negative beliefs or thoughts. The different steps in the cognitive restructuring process are summarized by the letters in the ABCDE acronym that describe the different stages of this coaching model: Activating event or situation associated with the negative thoughts, Beliefs and belief structures held by the individual that explain how they perceive the world which can facilitate negative thoughts, Consequences or feelings related to the activating event, Disputation of beliefs to allow individuals to challenge their belief system, and Effective new approach or effort to deal with the problem by facilitating individuals to replace unhelpful beliefs with more helpful ones. ii. Problem-Solving (also known as SOLVE) to raise awareness for specific triggers, and evaluate and choose more effective options. Each letter of the SOLVE acronym identifies different steps of the problem-solving process: Select a problem, generate Options, rate the Likely outcome of each option, choose the Very best option, and Evaluate how well each option worked. For example, a suicide attempt is reconceptualized as a failure in problem-solving. This treatment approach attempts to provide patients with a better sense of control over future emerging problems. iii. Re-attribution is a technique that enables patients to replace negative self-statements (eg, "it is all my fault") with different statements where responsibility is attributed more appropriately. Furthermore, decatastrophizing may help subjects, especially adolescents decide whether they may be overestimating the catastrophic nature of the precipitating event, and by allowing them to scale the event severity they learn to evaluate situations along a continuum rather than seeing them in black and white. iv. Affect Regulation techniques are often used with suicidal adolescents to teach them how to recognize stimuli that provoke negative emotions and how to mitigate the resulting emotional arousal through self-talk and relaxation.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy.
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
| | - Valeria Placenti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
| | - Luca Magnani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
| | - Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
| | - Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy
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Feeney A, Hock RS, Fava M, Hernández Ortiz JM, Iovieno N, Papakostas GI. Antidepressants in children and adolescents with major depressive disorder and the influence of placebo response: A meta-analysis. J Affect Disord 2022; 305:55-64. [PMID: 35247482 DOI: 10.1016/j.jad.2022.02.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/29/2021] [Accepted: 02/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are few available antidepressants for pediatric Major Depressive Disorder (MDD). The objective of this systematic review and meta-analysis was to review industry-funded studies of antidepressants in children and adolescents with MDD, and to better understand the contribution of study design and placebo response to the findings of these studies. METHODS Randomized, double-blind, placebo-controlled clinical trials that compared antidepressant with placebo for the acute treatment of MDD in children and/or adolescents were selected. Estimates of the standardized mean difference (SMD) in change in Children's Depression Rating Scale-Revised scores were pooled, after examining for heterogeneity. A random-effects meta-analysis was completed. RESULTS Thirty-four antidepressant-placebo comparisons, involving 6161 subjects, were included. The SMD among all studies was 0.12 (CI 0.08, 0.17; p < 0.001), a very small effect size, lower than that seen in studies of adults with MDD. When the meta-analysis was limited to studies with a low mean placebo response, the SMD increased to 0.19 and further increased to 0.22 when studies with at least a 50% chance of receiving placebo were included. LIMITATIONS Many studies focused on older children and younger adolescents. Our findings may not reflect antidepressant efficacy in older adolescents. CONCLUSIONS The modest SMD identified in this analysis may reflect study design factors and the application of antidepressants developed for adults to pediatric patients. Given the urgent clinical need for more pediatric MDD treatments, the influence of placebo response and the need for drug development tailored to this population should be considered in pediatric MDD trial design.
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Affiliation(s)
- Anna Feeney
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Rebecca S Hock
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Maurizio Fava
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Jesús M Hernández Ortiz
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Nadia Iovieno
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - George I Papakostas
- Clinical Trials Network and Institute, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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Therapeutic drug monitoring of sertraline in children and adolescents: A naturalistic study with insights into the clinical response and treatment of obsessive-compulsive disorder. Compr Psychiatry 2022; 115:152301. [PMID: 35248877 DOI: 10.1016/j.comppsych.2022.152301] [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: 10/02/2021] [Revised: 02/07/2022] [Accepted: 02/18/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sertraline is a selective serotonin reuptake inhibitor with specific indications in child and adolescent psychiatry. Notwithstanding its frequent use and clinical benefits, the relationship between pharmacokinetics, pharmacodynamics, efficacy, and tolerability of sertraline across indications, particularly in non-adult patients, is not fully understood. METHOD This naturalistic therapeutic drug monitoring (TDM) study was conducted in a transdiagnostic sample of children and adolescents treated with sertraline (n = 78; mean age, 14.22 ± 2.39; range, 7-18 years) within the prospective multicenter "TDM-VIGIL" project. Associations between dose, serum concentration, and medication-specific therapeutic and side effects based on the Clinical Global Impression scale were examined. Tolerability was measured qualitatively with the 56-item Pediatric Adverse Event Rating Scale. RESULTS A strong linear positive dose-serum concentration relationship (with dose explaining 45% of the variance in concentration) and significant effects of weight and co-medication were found. Neither dose nor serum concentration were associated with side effects. An overall mild-to-moderate tolerability profile of sertraline was observed. In contrast with the transdiagnostic analysis that did not indicate an effect of concentration, when split into depression (MDD) and obsessive-compulsive disorder (OCD) diagnoses, the probability of clinical improvement significantly increased as both dose and concentration increased for OCD, but not for MDD. CONCLUSIONS This TDM-flexible-dose study revealed a significant diagnosis-specific effect between sertraline serum concentration and clinical efficacy for pediatric OCD. While TDM already guides clinical decision-making regarding compliance, dose calibration, and drug-drug interactions, combining TDM with other methods, such as pharmacogenetics, may facilitate a personalized medicine approach in psychiatry.
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Xiang Y, Cuijpers P, Teng T, Li X, Fan L, Liu X, Jiang Y, Du K, Lin J, Zhou X, Xie P. Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:139. [PMID: 35193522 PMCID: PMC8862472 DOI: 10.1186/s12888-022-03760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/03/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although the clinical efficacy and safety of combination of pharmacotherapy and psychotherapy in the treatment of depressive disorders in children and adolescents have been studied, the results remain controversial. This meta-analysis aimed to study the short-term efficacy and acceptability of combined therapy for children and adolescents with depressive disorders. METHODS We conducted a systematic search in multiple databases for randomised controlled trials (RCTs), up to 31 December 2020, that assessed the combination of pharmacotherapy and psychotherapy against other active treatment options (pharmacotherapy, psychotherapy and placebo combined psychotherapy) in children and adolescents ( ≤ 18 years old) with depressive disorder. This study was registered with PROSPERO (CRD42020196701). RESULTS A total of 14 RCTs involving 1,325 patients were included. For the primary and secondary outcomes, there were no statistically significant differences between the compared interventions in terms of remission (odds ratios [OR] = 1.37; 95% confidence interval [CI]: 0.93 to 2.04), acceptability (OR = 0.99; 95% CI: 0.72 to 1.38), efficacy (standardised mean differences = -0.07; 95% CI: -0.32 to 0.19), and suicidality (OR = 1.17; 95% CI: 0.67 to 2.06). Limited evidence showed that the combination of fluoxetine (OR = 1.90, 95% CI: 1.10 to 3.29) or non-selective serotonin reuptake inhibitors (non-SSRI) (OR = 2.46, 95% CI: 1.06 to 5.72) with cognitive-behavioural therapy (CBT) was superior to other active treatment options. Most included trials were rated as 'some concerns' in terms of risk of bias assessment. CONCLUSION There is no evidence from the limited available data that all combined therapies are superior to other active treatment options for the acute treatment of depressive disorder in children and adolescents. However, it showed that fluoxetine or non-SSRI pharmacotherapies combined with CBT might be superior to other therapies in short-term. Mixed characteristics (e.g. age) and small sample size of non-SSRI combined therapy may influence the generalisability of the results.
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Affiliation(s)
- Yajie Xiang
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Pim Cuijpers
- grid.16872.3a0000 0004 0435 165XDepartment of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Teng Teng
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Xuemei Li
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Li Fan
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Xueer Liu
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Yuanliang Jiang
- grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China ,grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, China
| | - Kang Du
- grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China ,grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, China
| | - Jingyuan Lin
- grid.16872.3a0000 0004 0435 165XDepartment of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands ,grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, China
| | - Xinyu Zhou
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. .,Chongqing Key Laboratory of Neurobiology, Chongqing, China. .,Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Peng Xie
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China. .,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. .,Chongqing Key Laboratory of Neurobiology, Chongqing, China.
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Liu W, Li G, Wang C, Wang X, Yang L. Efficacy of Sertraline Combined with Cognitive Behavioral Therapy for Adolescent Depression: A Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5309588. [PMID: 34992673 PMCID: PMC8727125 DOI: 10.1155/2021/5309588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The efficacy of antidepressant drugs combined with psychotherapy is controversial; hence, this meta-analysis was conducted to assess the efficacy of the combination therapy. METHODS Relevant literature was searched in PubMed, Web of Science and Embase, Chinese databases CNKI, and WanFang Data. We included the literature on the comparison of the sertraline combined with cognitive behavioral therapy (CBT) and each treatment alone for adolescent depression published in 2000-2021. Meta-analysis was performed using Stata16.0 software. RESULTS A total of 421 relevant articles were retrieved, and 14 studies were finally included. In comparison with the control group (sertraline), sertraline combined with CBT achieved higher response rate (OR = 5.07, 95% CI: 3.00, 8.58) and lower incidence of adverse reactions (OR = 0.43, 95% CI: 0.24, 0.75). Before treatment, there were no significant differences in depression score, anxiety score, and symptom self-rating scale score between the two groups. After treatment, depression score (SMD = -2.79, 95% CI: -3.64, -1.94), anxiety score (SMD = -1.22, 95% CI: -1.96, -0.47), and symptom self-rating scale score (SMD = -1.73, 95% CI: -3.19, -0.27) were significantly lower in the combined treatment group than in the control group. CONCLUSION Although the number of comparative trials is small, this study shows that sertraline is effective for adolescent depression, but sertraline combined with CBT is more effective. The latter can significantly reduce the incidence of depressive symptoms, anxiety, and adverse reactions in patients. Therefore, this combination therapy is recommended for the clinical treatment of adolescent depression.
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Affiliation(s)
- Wenliang Liu
- Department of Psychological, Huai'an No. 3 People's Hospital, Huai'an, Jiangsu 223001, China
| | - Gongying Li
- Department of Psychological, Huai'an No. 3 People's Hospital, Huai'an, Jiangsu 223001, China
| | - Congjie Wang
- Department of Psychological, Huai'an No. 3 People's Hospital, Huai'an, Jiangsu 223001, China
| | - Xiuzhen Wang
- Department of Psychological, Huai'an No. 3 People's Hospital, Huai'an, Jiangsu 223001, China
| | - Lin Yang
- Department of Psychological, Huai'an No. 3 People's Hospital, Huai'an, Jiangsu 223001, China
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Courtney DB, Watson P, Chan BW, Bennett K, Krause KR, Offringa M, Butcher NJ, Monga S, Neprily K, Zentner T, Rodak T, Szatmari P. Forks in the road: Definitions of response, remission, recovery, and other dichotomized outcomes in randomized controlled trials for adolescent depression. A scoping review. Depress Anxiety 2021; 38:1152-1168. [PMID: 34312952 DOI: 10.1002/da.23200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Definitions of dichotomous outcome terms, such as "response," "remission," and "recovery" are central to the design, interpretation, and clinical application of randomized controlled trials of adolescent depression interventions. Accordingly, this scoping review was conducted to document how these terms have been defined and justified in clinical trials. METHOD Bibliographic databases MEDLINE, Embase, APA PsycInfo, and CINAHL were searched from inception to February 2020 for randomized controlled trials evaluating treatments for adolescent depression. Ninety-eight trials were included for data extraction and analysis. RESULTS Assessment of outcome measurement instruments, metric strategies, methods of aggregation, and measurement timing, yielded 53 unique outcome definitions of "response" across 45 trials that assessed response, 47 unique definitions of "remission" in 29 trials that assessed remission, and 19 unique definitions of "recovery" across 11 trials that assessed recovery. A minority of trials (N = 35) provided a rationale for dichotomous outcomes definitions, often by citing other studies that used a similar definition (N = 11). No rationale included input from youth or families with lived experience. CONCLUSION Our review revealed that definitions of "response," "remission," "recovery," and related terms are highly variable, lack clear rationales, and are not informed by key stakeholder input. These limitations impair pooling of trial results and the incorporation of trial findings into pragmatic treatment decisions in clinical practice. Systematic approaches to establishing outcome definitions are needed to enhance the impact of trials examining adolescent depression treatment.
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Affiliation(s)
- Darren B Courtney
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
| | - Priya Watson
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
| | | | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster Univeristy, Toronto, Ontario
| | | | - Martin Offringa
- Department of Pediatrics, Neonatology, University of Toronto, Toronto, Ontario
| | - Nancy J Butcher
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
| | - Suneeta Monga
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
| | - Kirsten Neprily
- Department of Psychology, School and Applied Child Psychology, University of Calgary, Calgary, Alberta
| | - Tabitha Zentner
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Peter Szatmari
- Department of Psychiatry, Child and Youth Mental Health, University of Toronto, Toronto, Ontario
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Méndez J, Sánchez-Hernández Ó, Garber J, Espada JP, Orgilés M. Psychological Treatments for Depression in Adolescents: More Than Three Decades Later. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094600. [PMID: 33926111 PMCID: PMC8123571 DOI: 10.3390/ijerph18094600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/29/2022]
Abstract
Depression is a common and impairing disorder which is a serious public health problem. For some individuals, depression has a chronic course and is recurrent, particularly when its onset is during adolescence. The purpose of the current paper was to review the clinical trials conducted between 1980 and 2020 in adolescents with a primary diagnosis of a depressive disorder, excluding indicated prevention trials for depressive symptomatology. Cognitive behavioral therapy (CBT) is the pre-eminent treatment and is well established from an evidence-based treatment perspective. The body of research on the remaining treatments is smaller and the status of these treatments is varied: interpersonal therapy (IPT) is well established; family therapy (FT) is possibly effective; and short-term psychoanalytic therapy (PT) is experimental treatment. Implementation of the two treatments that work well-CBT and IPT-has more support when provided individually as compared to in groups. Research on depression treatments has been expanding through using transdiagnostic and modular protocols, implementation through information and communication technologies, and indicated prevention programs. Despite significant progress, however, questions remain regarding the rate of non-response to treatment, the fading of specific treatment effects over time, and the contribution of parental involvement in therapy.
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Affiliation(s)
- Javier Méndez
- Department of Personality, Assessment and Psychological Treatment, University of Murcia, 30100 Murcia, Spain
- Correspondence:
| | - Óscar Sánchez-Hernández
- Department of Developmental and Educational Psychology, University of Murcia, 30100 Murcia, Spain;
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN 37302, USA;
| | - José P. Espada
- Department of Health Psychology, Miguel Hernández University, 03202 Elche, Spain; (J.P.E.); (M.O.)
| | - Mireia Orgilés
- Department of Health Psychology, Miguel Hernández University, 03202 Elche, Spain; (J.P.E.); (M.O.)
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11
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Yang Q, Ling Y, Huebner ES, Zeng Y, Liu C. Assessing the Measurement Invariance of the Children's Hope Scale in Chinese and American Adolescents. J Pers Assess 2019; 103:195-203. [PMID: 31859536 DOI: 10.1080/00223891.2019.1693387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Previous studies of the Children's Hope Scale (CHS) have not compared its factor structure using samples of Chinese early adolescents and American early adolescents. Contrary to expectations, the one-factor model revealed a better fit for the Chinese sample (N = 1184) whereas the two-factor model revealed a better fit for the American sample (N = 1049). Full measurement invariance was not demonstrated for the two-factor model of the CHS with the Chinese adolescents. This finding indicated that researchers should not make mean level comparisons between the two factors of agency and pathways across early adolescents from these two nations. Partial scalar invariance was achieved for the one-factor model, which suggested that researchers may tentatively make comparisons between Chinese and American early adolescents using CHS total scores. Although caution should be exercised in interpreting the mean differences, Chinese adolescents reported a lower total mean level of hope than American adolescents. Differences in the findings are discussed within the collectivism-individualism framework.
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Affiliation(s)
- Qin Yang
- College of Education, Hunan Agricultural University, Changsha, China
| | - Yu Ling
- College of Education, Hunan Agricultural University, Changsha, China
| | - E Scott Huebner
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Yifang Zeng
- College of Education, Texas Tech University, Lubbock, Texas
| | - Caili Liu
- College of Education, Hunan Agricultural University, Changsha, China
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12
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Bernal G, Rivera-Medina CL, Cumba-Avilés E, Reyes-Rodríguez ML, Sáez-Santiago E, Duarté-Vélez Y, Nazario L, Rodríguez-Quintana N, Rosselló J. Can Cognitive-Behavioral Therapy Be Optimized With Parent Psychoeducation? A Randomized Effectiveness Trial of Adolescents With Major Depression in Puerto Rico. FAMILY PROCESS 2019; 58:832-854. [PMID: 31077610 DOI: 10.1111/famp.12455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This is a longitudinal randomized control trial on the impact of adding a parent psychoeducation intervention (TEPSI) as part of cognitive-behavioral therapy (CBT) for adolescents with Major Depressive Disorder (MDD) in a Puerto Rican sample. We tested the efficacy of adding 8 group sessions of TEPSI to 12 sessions of individual CBT on reducing depressive symptoms, MDD diagnosis, and improving family functioning. Participants (n = 121) were randomized to individual CBT with or without TEPSI. No main group effects were found for most patient domains including depression symptoms, as well as presence of adolescent's MDD diagnosis at posttreatment. Results did show a main effect of CBT over time for depression symptoms, suicide ideation, family criticism, and the presence of MDD diagnosis decreasing from pre- to postintervention. A year post treatment, almost 70% of adolescents in both conditions (CBT and CBT + TEPSI) remained in remission. A main effect was obtained for treatment in the adolescent's perception of familism and family emotional involvement. The primary hypothesis that family psychoeducation would optimize CBT for depression in adolescents was not supported. Both conditions yielded similar clinical end points. The culturally adapted CBT was found effective with Latino/a adolescents showing clinically significant improvements from pretreatment to posttreatment and remained stable at a 1-year follow-up. Regarding family outcomes, adolescents in CBT + TEPSI remained stable from pretreatment to posttreatment on family emotional involvement, while adolescents in CBT-alone showed an increase. The implication of these findings is discussed.
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Affiliation(s)
- Guillermo Bernal
- University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico
| | | | | | | | | | | | - Lelis Nazario
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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13
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Dhami P, Knyahnytska Y, Atluri S, Lee J, Courtney DB, Croarkin PE, Blumberger DM, Daskalakis ZJ, Farzan F. Feasibility and clinical effects of theta burst stimulation in youth with major depressive disorders: An open-label trial. J Affect Disord 2019; 258:66-73. [PMID: 31398593 DOI: 10.1016/j.jad.2019.07.084] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Conventional treatments for youth depression, such as antidepressants, have modest efficacy, side effects, and ongoing controversies regarding safety. Repetitive transcranial magnetic stimulation (rTMS), specifically theta burst stimulation (TBS), applied to the dorsolateral prefrontal cortex (DLPFC) has demonstrated efficacy for the treatment of depression in adults. However, the feasibility and clinical response to TBS for youth depression has yet to be explored. METHODS Twenty participants between the ages of 16 to 24 years old with MDD were recruited. The intervention consisted of 10 treatment sessions over the course of two weeks, in which participants received intermittent TBS and continuous TBS stimulation to the left and right DLPFC, respectively. Change in the Hamilton Rating Scale for Depression (HRSD-17) score was the primary outcome. Clinical assessments occurred at baseline, after the fifth treatment session, and within a week after treatment completion. RESULTS Of the twenty participants, eighteen received all TBS sessions, and seventeen completed all clinical assessments. There was a significant reduction in depressive symptoms following treatment completion (p < 0.001). Four of the twenty patients had more than 50% reduction in their depressive symptoms, two of whom achieved remission. All participants received and tolerated at least six daily TBS treatments with no major adverse events. LIMITATIONS Study was an uncontrolled, open-label design. CONCLUSION Ten sessions of TBS was feasible, well tolerated, and appeared to have clinical effects for the treatment of depressed youth. Future sham-controlled randomized trials are warranted to validate these findings in a larger cohort of youth depression.
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Affiliation(s)
- Prabhjot Dhami
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, Ontario, M6J 1A8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Yuliya Knyahnytska
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, Ontario, M6J 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada
| | - Sravya Atluri
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, Ontario, M6J 1A8, Canada; Institute of Biomaterial and Biomedical Engineering, Rosebrugh Building, Room 407, 164 College St, Toronto, Ontario, M5S 3G9, Canada
| | - Jonathan Lee
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, Ontario, M6J 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Darren B Courtney
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, Ontario, M6J 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada
| | | | - Daniel M Blumberger
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, Ontario, M6J 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, Ontario, M6J 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Faranak Farzan
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, Ontario, M6J 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada; School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Avenue, Surrey, British Columbia, V3T 0A3, Canada.
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The addition of fluoxetine to cognitive behavioural therapy for youth depression (YoDA-C): a randomised, double-blind, placebo-controlled, multicentre clinical trial. Lancet Psychiatry 2019; 6:735-744. [PMID: 31371212 DOI: 10.1016/s2215-0366(19)30215-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Medication is commonly used to treat youth depression, but whether medication should be added to cognitive behavioural therapy (CBT) as first-line treatment is unclear. We aimed to examine whether combined treatment with CBT and fluoxetine was more effective than CBT and placebo in youth with moderate-to-severe major depressive disorder. METHODS The Youth Depression Alleviation-Combined Treatment (YoDA-C) trial was a randomised, double-blind, placebo-controlled, multicentre clinical trial. Participants were aged 15-25 years with moderate-to-severe MDD and had sought care at one of four clinical centres in metropolitan Melbourne, Australia. Patients were randomly assigned (1:1) to receive CBT for 12 weeks, plus either fluoxetine or placebo. Participants began on one 20 mg capsule of fluoxetine or one placebo pill per day. All participants received CBT, delivered by therapists in weekly 50-minute sessions and attended interviews at baseline, and at weeks 4, 8, and 12, during which they completed assessments with research assistants. Participants saw a psychiatrist or psychiatry trainee to complete medical assessments at the same timepoints. The primary outcome was change in the interviewer-rated Montgomery-Åsberg Depression Rating Scale (MADRS) score at 12 weeks. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001281886). FINDINGS 153 participants (mean age 19·6 years [SD 2·7]) were enrolled from Feb 20, 2013, to Dec 13, 2016. 77 (50%) patients were allocated to CBT and placebo and 76 (50%) to CBT and fluoxetine. Participants had severe depression at baseline (mean MADRS score 33·6 [SD 5·1] in the CBT and placebo group and 32·2 [5·6] in the CBT and fluoxetine group), with high proportions of participants with anxiety disorder comorbidity (47 [61%] in the CBT and placebo group and 49 [64%] in the CBT and fluoxetine group) and past-month suicidal ideation (55 [71%] in the CBT and placebo group and 59 [78%] in the CBT and fluoxetine group). 59 (77%) participants in the CBT and placebo group and 64 (84%) in the CBT and fluoxetine group completed follow-up at week 12. After 12 weeks of treatment both groups showed a reduction in MADRS scores (-13·7, 95% CI -16·0 to -11·4, in the CBT and placebo group and -15·1, -17·4 to -12·9, in the CBT and fluoxetine group). There was no significant between-group difference in MADRS scores (-1·4, -4·7 to 1·8; p=0·39). There were five suicide attempts in the CBT and placebo group and one suicide attempt in the CBT and fluoxetine group (odds ratio 0·2, 0·0-1·8; p=0·21), and no significant between-group differences for other suicidal behaviours. INTERPRETATION We did not find evidence that the addition of fluoxetine (rather than placebo) to CBT further reduced depressive symptoms in young people with moderate-to-severe MDD. Exploratory analyses showed that the addition of medication might be helpful for patients with comorbid anxiety symptoms and for older youth. FUNDING Australian National Health and Medical Research Council.
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15
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Vitiello B. Youth depression: are two treatments better than one? Lancet Psychiatry 2019; 6:714-715. [PMID: 31371211 DOI: 10.1016/s2215-0366(19)30281-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.
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16
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Estimating patient-specific treatment advantages in the 'Treatment for Adolescents with Depression Study'. J Psychiatr Res 2019; 112:61-70. [PMID: 30856378 DOI: 10.1016/j.jpsychires.2019.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 01/12/2019] [Accepted: 02/25/2019] [Indexed: 11/23/2022]
Abstract
The 'Treatment for Adolescents with Depression Study' (TADS, ClinicalTrials.gov, identifier: NCT00006286) was a cornerstone, randomized controlled trial evaluating the effectiveness of standard treatment options for major depression in adolescents. Whereas previous TADS analyses examined primarily effect modifications of treatment-placebo differences by various patient characteristics, less is known about the modification of inter-treatment differences, and hence, patient characteristics that might guide treatment selection. We sought to fill this gap by estimating patient-specific inter-treatment differences as a function of patients' baseline characteristics. We did so by applying the 'model-based random forest', a recently-introduced machine learning-based method for evaluating effect heterogeneity that allows for the estimation of patient-specific treatment effects as a function of arbitrary baseline characteristics. Treatment conditions were cognitive-behavioural therapy (CBT) alone, fluoxetine (FLX) alone, and the combination of CBT and fluoxetine (COMB). All inter-treatment differences (CBT vs. FLX; CBT vs. COMB; FLX vs. COMB) were evaluated across 23 potential effect modifiers extracted from previous studies. Overall, FLX was superior to CBT, while COMB was superior to both CBT and FLX. Evidence for effect heterogeneity was found for the CBT-FLX difference and the FLX-COMB difference, but not for the CBT-COMB difference. Baseline depression severity modified the CBT-FLX difference; whereas baseline depression severity, patients' treatment expectations, and childhood trauma modified the FLX-COMB difference. All modifications were quantitative rather than qualitative, however, meaning that the differences varied only in magnitude, but not direction. These findings imply that combining CBT with fluoxetine may be superior to either therapy used alone across a broad range of patients.
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"Teaching Moments" in Psychotherapy: Addressing Emergent Life Events Using Strategies From a Modular Evidence-Based Treatment. Behav Ther 2019; 50:101-114. [PMID: 30661551 PMCID: PMC6343500 DOI: 10.1016/j.beth.2018.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/04/2018] [Accepted: 03/29/2018] [Indexed: 11/22/2022]
Abstract
Emergent life events (ELEs) are unexpected, acute client stressors reported in psychotherapy sessions that are associated with reduced evidence-based treatment (EBT) integrity and client progress. As a potential solution, this study examined the extent to which ELEs could be appropriately addressed using existing EBT strategies. Participants were 34 low-income youth (ages 5-15, 50% male, 85% Latino) seen by 18 therapy providers in the modular EBT condition (MATCH) of a community effectiveness trial. MATCH experts rated descriptions of 75 ELEs from therapy sessions on how well they might be addressed clinically by any of MATCH's 33 strategies for youth anxiety, depression, trauma, or conduct problems (i.e., "addressability"). MATCH-expert ratings were compared with observationally coded provider responses to ELEs. Results revealed that when assuming the presence of youth and caregiver in session, two-thirds of ELEs were identified as fully addressable and nearly all ELEs (96%) were partially addressable. ELEs related to family issues were most common but least likely to be addressable. Problem Solving and Relaxation skills could address the greatest percentage (87%) of ELEs. The most common supplemental content not explicitly prescribed in MATCH, but identified as necessary to fully address ELEs, was "assessing and empathic listening." Provider responses were often incongruent with MATCH-expert raters regarding which strategies to use for which ELEs. In summary, most ELEs reported in a diverse community sample could be theoretically harnessed as "teaching moments" for skills within an existing, multi-problem EBT. However, providers may benefit from development of a structured resource to guide them in choosing the most effective response when these unexpected events arise.
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18
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Foster S, Mohler-Kuo M. Treating a broader range of depressed adolescents with combined therapy. J Affect Disord 2018; 241:417-424. [PMID: 30145512 DOI: 10.1016/j.jad.2018.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/26/2018] [Accepted: 08/07/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Traditional statistical analyses of clinical trials encompass the central tendency of outcomes and, hence, are restricted to a treatment's average effectiveness. Our aim was to get a more complete picture of the effectiveness of standard treatment options for adolescent depression, by analyzing treatment effects across low, middle, and high levels of response. METHODS Secondary data analysis was performed of the Treatment for Adolescents with Depression Study (TADS, ClinicalTrials.gov, NCT00006286), a randomized controlled trial comparing fluoxetine (FLX), cognitive-behavioral therapy (CBT), and their combination (COMB) against placebo treating adolescents with major depression (n = 439). The proportional change from baseline to week 12 in the Children's Depression Rating Scale-Revised was used as an index of response. Response levels were analyzed via quantile regression models, thereby estimating treatment effects across the entire response level distribution, adjusted for baseline depression, study site, and patients' treatment expectancies. RESULTS Whereas CBT was no more effective than placebo across response levels, COMB was more effective than FLX in that its quantile treatment effects were both larger in magnitude and spread out across a broader range of response levels, including the low end of the response level distribution. Cohen's d of the difference was 1.39 (95% confidence interval 1.33-1.45). LIMITATIONS Ad-hoc analysis using data from a trial that was not originally designed to accommodate such analysis. CONCLUSION The combination of cognitive-behavioral therapy and fluoxetine was more effective than either treatment used alone, not just in average effectiveness, but in the breadth of patients in whom it was effective.
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Affiliation(s)
- Simon Foster
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zürich, Switzerland; Swiss Research Institute for Public Health and Addiction associated with the University of Zurich, Konradstrasse 32, 8031 Zurich, Switzerland.
| | - Meichun Mohler-Kuo
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zürich, Switzerland; Swiss Research Institute for Public Health and Addiction associated with the University of Zurich, Konradstrasse 32, 8031 Zurich, Switzerland; La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Av. Vinet 30, 1004 Lausanne, Switzerland
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Hussain H, Dubicka B, Wilkinson P. Recent developments in the treatment of major depressive disorder in children and adolescents. EVIDENCE-BASED MENTAL HEALTH 2018; 21:101-106. [PMID: 30045844 PMCID: PMC10270457 DOI: 10.1136/eb-2018-102937] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 01/22/2023]
Abstract
Major depressive disorder in adolescents is an important public health concern. It is common, a risk factor for suicide and is associated with adverse psychosocial consequences. The UK National Institute for Health and Care Excellence guidelines recommend that children and young people with moderate-to-severe depression should be seen within Child and Adolescent Mental Health Services and receive specific psychological interventions, possibly in combination with antidepressant medication. Cognitive behavioural therapy (in some studies) and interpersonal psychotherapy have been demonstrated to be more effective than active control treatments for depressed adolescents. For children with depression, there is some evidence that family focused approaches are more effective than individual therapy. Fluoxetine is the antidepressant with the greatest evidence for effectiveness compared with placebo. Treatment with antidepressants and/or psychological therapy is likely to reduce suicidality, although in some young people, selective serotonin reuptake inhibitors lead to increased suicidality. There is limited evidence that combination of specific psychological therapy and antidepressant medication is better than treatment with monotherapy. There are methodological limitations in the published literature that make it difficult to relate study findings to the more severely ill clinical population in Child and Adolescent Mental Health Services. Young people should have access to both evidence-based psychological interventions and antidepressants for paediatric depression. Collaborative decisions on treatment should be made jointly by young people, their carers and clinicians, taking into account individual circumstances and potential benefits, risks and availability of treatment.
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Affiliation(s)
- Haseena Hussain
- Academic Clinical Fellow and Specialty Registrar in Child and Adolescent Psychiatry, University of Cambridge and Hertfordshire Partnership University NHS Foundation Trust, Cambridge, UK
| | - Bernadka Dubicka
- Consultant Child and Adolescent Psychiatrist, Pennine Care Foundation trust and honorary reader, University of Manchester, UK
| | - Paul Wilkinson
- Consultant and clinical Lecturer in Child and Adolescent Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Melvin GA, Tonge BJ, Mulraney M, Gordon M, Taffe J, Klimkeit E. The Cranky Thermometers: Visual analogue scales measuring irritability in youth. J Adolesc 2018; 64:146-154. [PMID: 29475011 DOI: 10.1016/j.adolescence.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 11/15/2022]
Abstract
This study assessed the psychometric properties of two visual analogue scales of irritability, known as the Cranky Thermometers (CT), in both an Australian community secondary-school sample (N = 164) and a sample of adolescents with a depressive disorder (N = 127). The first scale Cranky Now measures current irritability, and the second, Cranky Two Weeks, measures peak irritability within the last two weeks. CT scores were significantly higher in adolescents with major depressive disorder than in the school sample and showed improvement following treatment for depression. Positive associations were found between CT and irritability scores as determined by Kiddie Schedule for Affective Disorders and Schizophrenia (not irritable, sub-threshold, threshold irritability) and Affective Reactivity Index scores. Results suggest that the CTs are rapidly administered, have promising psychometric properties and demonstrate utility in measuring irritability in clinical and community settings.
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Affiliation(s)
- Glenn A Melvin
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Building #1, Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia.
| | - Bruce J Tonge
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Building #1, Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia
| | - Melissa Mulraney
- Centre for Community Child Health, Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville, Victoria, 3052, Australia
| | - Michael Gordon
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Building #1, Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia; Early in Life Mental Health Service, Southern Health, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria, 3168, Australia
| | - John Taffe
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Building #1, Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia
| | - Ester Klimkeit
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Building #1, Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia
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Radovic S, Melvin GA, Gordon MS. Clinician perspectives and practices regarding the use of exercise in the treatment of adolescent depression. J Sports Sci 2017; 36:1371-1377. [PMID: 28945524 DOI: 10.1080/02640414.2017.1383622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Initial evidence suggests that exercise is an effective method in reducing symptoms of depression amongst adolescents. It is important to examine clinician attitudes and practices regarding the incorporation of exercise in mental health treatment, and to examine potential facilitators and barriers to exercise prescription. An online survey was conducted amongst mental health clinicians (N = 125) working in the treatment of adolescent depression. Clinicians held favourable attitudes towards exercise, most frequently ranking exercise as the second most important treatment for adolescent depression following cognitive behaviour therapy. The majority of clinicians were found to prescribe exercise "always" (24.3%) or "most of the time" (43.4%). Significant positive relationships were found between confidence to prescribe exercise and knowledge surrounding exercise prescription and clinician exercise prescription rates, however no significant relationship was identified between clinician levels of exercise and exercise prescription. The most frequently endorsed barriers to exercise prescription included the belief that exercise prescription should be implemented by an exercise professional, a lack of knowledge surrounding exercise prescription for adolescent depression, and the belief that depressed adolescents will not adhere to an exercise program. Overall, clinicians held positive attitudes towards exercise in the treatment of adolescent depression, and often recommended exercise as part of treatment.
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Affiliation(s)
- Sara Radovic
- a Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health , Monash University , Notting Hill , Australia
| | - Glenn Alexander Melvin
- b Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - Michael Solomon Gordon
- b Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
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Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial. Child Psychiatry Hum Dev 2017; 48:485-497. [PMID: 27485100 DOI: 10.1007/s10578-016-0675-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11-16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates.
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Rohden AI, Benchaya MC, Camargo RS, Moreira TDC, Barros HM, Ferigolo M. Dropout Prevalence and Associated Factors in Randomized Clinical Trials of Adolescents Treated for Depression: Systematic Review and Meta-analysis. Clin Ther 2017; 39:971-992.e4. [DOI: 10.1016/j.clinthera.2017.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/02/2017] [Accepted: 03/13/2017] [Indexed: 12/29/2022]
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Wright B, Tindall L, Littlewood E, Allgar V, Abeles P, Trépel D, Ali S. Computerised cognitive-behavioural therapy for depression in adolescents: feasibility results and 4-month outcomes of a UK randomised controlled trial. BMJ Open 2017; 7:e012834. [PMID: 28132000 PMCID: PMC5278287 DOI: 10.1136/bmjopen-2016-012834] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/16/2016] [Accepted: 09/19/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Computer-administered cognitive-behavioural therapy (CCBT) may be a promising treatment for adolescents with depression, particularly due to its increased availability and accessibility. The feasibility of delivering a randomised controlled trial (RCT) comparing a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression was evaluated. DESIGN Single centre RCT feasibility study. SETTING The trial was run within community and clinical settings in York, UK. PARTICIPANTS Adolescents (aged 12-18) with low mood/depression were assessed for eligibility, 91 of whom met the inclusion criteria and were consented and randomised to Stressbusters (n=45) or websites (n=46) using remote computerised single allocation. Those with comorbid physical illness were included but those with psychosis, active suicidality or postnatal depression were not. INTERVENTIONS An eight-session CCBT program (Stressbusters) designed for use with adolescents with low mood/depression was compared with an attention control (accessing low mood self-help websites). PRIMARY AND SECONDARY OUTCOME MEASURES Participants completed mood and quality of life measures and a service Use Questionnaire throughout completion of the trial and 4 months post intervention. Measures included the Beck Depression Inventory (BDI) (primary outcome measure), Mood and Feelings Questionnaire (MFQ), Spence Children's Anxiety Scale (SCAS), the EuroQol five dimensions questionnaire (youth) (EQ-5D-Y) and Health Utility Index Mark 2 (HUI-2). Changes in self-reported measures and completion rates were assessed by treatment group. RESULTS From baseline to 4 months post intervention, BDI scores and MFQ scores decreased for the Stressbusters group but increased in the website group. Quality of life, as measured by the EQ-5D-Y, increased for both groups while costs at 4 months were similar to baseline. Good feasibility outcomes were found, suggesting the trial process to be feasible and acceptable for adolescents with depression. CONCLUSIONS With modifications, a fully powered RCT is achievable to investigate a promising treatment for adolescent depression in a climate where child mental health service resources are limited. TRIAL REGISTRATION NUMBER ISRCTN31219579.
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Affiliation(s)
- Barry Wright
- University of York (Child Oriented Mental health Intervention Centre – COMIC), Adolescent and Family Unit, York, UK
| | - Lucy Tindall
- Leeds and York Partnership NHS Foundation Trust (Child Oriented Mental health Intervention Centre – COMIC), York, UK
| | | | | | - Paul Abeles
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Rith-Najarian LR, Park AL, Wang T, Etchison AI, Chavira DA, Chorpita BF. Applying new evidence standards to youth cognitive behavioral therapies - A review. Behav Res Ther 2017; 90:147-158. [PMID: 28061375 DOI: 10.1016/j.brat.2016.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 11/11/2016] [Accepted: 12/16/2016] [Indexed: 12/19/2022]
Abstract
This review included 136 published randomized controlled trials (RCTs) of youth cognitive behavioral therapy (CBT) treatments. We aimed to test the premise that evidence-based youth treatments can be better differentiated from each other by applying more nuanced standards of evidence. Accordingly, we applied three standards to this article sample to determine how many treatments produced significant results: (a) on multiple target symptom measures, (b) at follow-up, and/or (c) against an active comparison group. We identified how many trials met standards individually and in combination. Although 87 of the 136 articles produced at least one significant treatment result at post-assessment, the subsets of "passing" articles were smaller and varied for any one of our three standards, with only 11 articles (8%) meeting all three standards simultaneously. Implications are discussed regarding the definition of "evidence-based," the need for multi-parameter filtering in treatment selection and clinical decision making, and future directions for research. We ultimately argue the value in assessing youth treatments for different types of evidence, which is better achieved through dynamic sets of standards, rather than a single approach to assessing general strength of evidence.
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Affiliation(s)
- Leslie R Rith-Najarian
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA.
| | - Alayna L Park
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Tina Wang
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Ana I Etchison
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Denise A Chavira
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
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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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Garber J, Brunwasser SM, Zerr AA, Schwartz KTG, Sova K, Weersing VR. Treatment and Prevention of Depression and Anxiety in Youth: Test of Cross-Over Effects. Depress Anxiety 2016; 33:939-959. [PMID: 27699941 PMCID: PMC5094283 DOI: 10.1002/da.22519] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 11/06/2022] Open
Abstract
Anxiety and depression are highly comorbid and share several common etiological processes. Therefore, it may be more efficient to develop interventions that treat or prevent these problems together rather than as separate entities. The present meta-analytic review examined whether interventions for children and adolescents that explicitly targeted either anxiety or depression showed treatment specificity or also impacted the other outcome (i.e. cross-over effects). We addressed this question both within the same type of study (i.e. treatment, prevention) and across study types. Only randomized controlled trials (RCTs) that assessed both constructs with dimensional measures were included in this review. For treatment studies, RCTs targeting anxiety (n = 18) showed significant effects on both anxious and depressive symptoms, although more strongly on anxiety than depression; similarly, RCTs treating depression (n = 9) yielded significant effects on both depressive and anxious symptoms, but stronger effects on depression than anxiety. Thus, there were cross-over effects in treatments purportedly targeting either anxiety or depression, and also treatment specificity, such that larger effects were seen for the target problem at which the treatment was aimed. Anxiety prevention studies (n = 14) significantly affected anxious, but not depressive symptoms, indicating no cross-over effect of anxiety prevention trials on depression. For depression prevention studies (n = 15), the effects were not significant for either depressive or anxiety symptoms, although the effect was significantly larger for depressive than for anxious symptoms. Post-hoc analyses revealed that the effect on depressive symptoms was significant in depression preventions trials of targeted but not universal samples. Implications for transdiagnostic interventions are discussed.
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Affiliation(s)
- Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee.
| | - Steven M Brunwasser
- Division of Allergy, Pulmonary, & Critical Care Medicine, Vanderbilt University School of Medicine
| | - Argero A Zerr
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - Karen T G Schwartz
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - Karen Sova
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - V Robin Weersing
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology
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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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Bingol F, Buzlu S. Effect of the Cognitive-Behavioral Prevention Program on Levels of Depression Symptoms Among Working Adolescents in Turkey. J Psychosoc Nurs Ment Health Serv 2016; 54:43-51. [DOI: 10.3928/02793695-20160616-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/25/2016] [Indexed: 11/20/2022]
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Karazsia BT, Schultz MM. Could Dissemination of Effective Psychotherapies Prevent Antidepressant Contamination of Water and Aquatic Organisms? ECOPSYCHOLOGY 2016. [DOI: 10.1089/eco.2015.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kwan B, Rickwood DJ. A systematic review of mental health outcome measures for young people aged 12 to 25 years. BMC Psychiatry 2015; 15:279. [PMID: 26573269 PMCID: PMC4647516 DOI: 10.1186/s12888-015-0664-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/27/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental health outcome measures are used to monitor the quality and effectiveness of mental health services. There is also a growing expectation for implementation of routine measurement and measures being used by clinicians as a feedback monitoring system to improve client outcomes. The recent focus in Australia and elsewhere targeting mental health services to young people aged 12-25 years has meant that outcome measures relevant to this age range are now needed. This is a shift from the traditional divide of child and adolescent services versus adult services with a transitioning age at 18 years. This systematic review is the first to examine mental health outcome measures that are appropriate for the 12 to 25 year age range. METHODS MEDLINE and PsychINFO databases were systematically searched to identify studies using mental health outcome measures with young people aged 12 to 25 years. The search strategy complied with the relevant sections of the PRISMA statement. RESULTS A total of 184 published articles were identified, covering 29 different outcome measures. The measures were organised into domains that consisted of eight measures of cognition and emotion, nine functioning measures, six quality of life measures, and six multidimensional mental health measures. No measures were designed specifically for young people aged 12 to 25 years and only two had been used by clinicians as a feedback monitoring system. Five measures had been used across the whole 12 to 25 year age range, in a range of mental health settings and were deemed most appropriate for this age group. CONCLUSIONS With changes to mental health service systems that increasingly focus on early intervention in adolescence and young adulthood, there is a need for outcome measures designed specifically for those aged 12 to 25 years. In particular, multidimensional measures that are clinically meaningful need to be developed to ensure quality and effectiveness in youth mental health. Additionally, outcome measures can be clinically useful when designed to be used within routine feedback monitoring systems.
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Affiliation(s)
- Benjamin Kwan
- Faculty of Health, University of Canberra, Kirinari Street, Bruce, ACT, 2601, Australia.
| | - Debra J Rickwood
- Faculty of Health, University of Canberra, Kirinari Street, Bruce, ACT, 2601, Australia.
- Headspace National Youth Mental Health Foundation National Office, 485 La Trobe Street, Melbourne, VIC, 3000, Australia.
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32
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Developmentally sensitive cognitive behavioral therapy for adolescent school refusal: rationale and case illustration. Clin Child Fam Psychol Rev 2015; 17:191-215. [PMID: 24338067 DOI: 10.1007/s10567-013-0160-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
School refusal can be difficult to treat and the poorest treatment response is observed among older school refusers. This poor response may be explained, in part, by the impact of developmental transitions and tasks upon the young person, their family, and the treatment process. This paper describes and illustrates the @school program, a cognitive behavioral therapy (CBT) designed to promote developmental sensitivity when planning and delivering treatment for adolescent school refusal. Treatment is modularized and it incorporates progress reviews, fostering a planned yet flexible approach to CBT. The treatment is illustrated in the case of Allison, a 16-year-old female presenting with major depressive disorder and generalized anxiety disorder. A case formulation guided the selection, sequencing, and pacing of modules targeting predisposing, precipitating, perpetuating, and protective factors. Treatment comprised 16 sessions with Allison (interventions addressing depression, anxiety, and school attendance) and 15 concurrent sessions with her mother (strategies to facilitate an adolescent's school attendance), including two sessions with Allison and mother together (family communication and problem solving to reduce parent-adolescent conflict). Two treatment-related consultations were also conducted with Allison's homeroom teacher. Allison's school attendance improved during the course of treatment. By post-treatment, there was a decrease in internalizing behavior, an increase in self-efficacy, and remission of depressive disorder and anxiety disorder. Clinically significant treatment gains were maintained at 2-month follow-up. Factors influencing outcome may include those inherent to the @school program together with less specific factors. Special consideration is given to parents' use of both authoritative and autonomy-granting approaches when helping an adolescent to attend school.
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Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM, Katona C, Lewis G, Malizia A, McAllister-Williams RH, Ramchandani P, Scott J, Taylor D, Uher R. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29:459-525. [PMID: 25969470 DOI: 10.1177/0269881115581093] [Citation(s) in RCA: 399] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
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Affiliation(s)
- Anthony Cleare
- Professor of Psychopharmacology & Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - C M Pariante
- Professor of Biological Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - A H Young
- Professor of Psychiatry and Chair of Mood Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - I M Anderson
- Professor and Honorary Consultant Psychiatrist, University of Manchester Department of Psychiatry, University of Manchester, Manchester, UK
| | - D Christmas
- Consultant Psychiatrist, Advanced Interventions Service, Ninewells Hospital & Medical School, Dundee, UK
| | - P J Cowen
- Professor of Psychopharmacology, Psychopharmacology Research Unit, Neurosciences Building, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - C Dickens
- Professor of Psychological Medicine, University of Exeter Medical School and Devon Partnership Trust, Exeter, UK
| | - I N Ferrier
- Professor of Psychiatry, Honorary Consultant Psychiatrist, School of Neurology, Neurobiology & Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Geddes
- Head, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Gilbody
- Director of the Mental Health and Addictions Research Group (MHARG), The Hull York Medical School, Department of Health Sciences, University of York, York, UK
| | - P M Haddad
- Consultant Psychiatrist, Cromwell House, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - C Katona
- Division of Psychiatry, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - A Malizia
- Consultant in Neuropsychopharmacology and Neuromodulation, North Bristol NHS Trust, Rosa Burden Centre, Southmead Hospital, Bristol, UK
| | - R H McAllister-Williams
- Reader in Clinical Psychopharmacology, Institute of Neuroscience, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P Ramchandani
- Reader in Child and Adolescent Psychiatry, Centre for Mental Health, Imperial College London, London, UK
| | - J Scott
- Professor of Psychological Medicine, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Taylor
- Professor of Psychopharmacology, King's College London, London, UK
| | - R Uher
- Associate Professor, Canada Research Chair in Early Interventions, Dalhousie University, Department of Psychiatry, Halifax, NS, Canada
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Gunlicks-Stoessel M, Mufson L, Westervelt A, Almirall D, Murphy S. A Pilot SMART for Developing an Adaptive Treatment Strategy for Adolescent Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 45:480-94. [PMID: 25785788 DOI: 10.1080/15374416.2015.1015133] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This pilot study was conducted to assess the feasibility and acceptability of 4 adaptive treatment strategies (ATSs) for adolescent depression to plan for a subsequent full-scale clinical trial. The ATSs aim to address 2 questions that arise when personalizing treatment: (a) For adolescents treated with Interpersonal Psychotherapy for depressed adolescents (IPT-A; Mufson et al., 2004 ), at what time point should therapists make the determination that the adolescent is not likely to respond if the initial treatment plan is continued (week 4 or week 8)? (b) For adolescents who are judged to need their treatment augmented, should the therapist increase the number of IPT-A sessions or add pharmacotherapy (fluoxetine)? A 16-week pilot sequential multiple assignment randomized trial (SMART) was conducted with 32 adolescents (M age = 14.9) who had a diagnosis of major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified. Adolescents were primarily female (75%) and Caucasian (84.4%). Data regarding the feasibility and acceptability of the study and treatment procedures and treatment response rates were collected. Week 4 was the more feasible and acceptable decision point for assessing need for a change to treatment. Adolescents, parents, and therapists reported a range of attitudes about medication and more intensive therapy as treatment options. Results from the pilot study have yielded additional research questions for the full-scale SMART and will improve our ability to successfully conduct the trial.
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Affiliation(s)
| | - Laura Mufson
- b Department of Psychiatry , Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute
| | | | | | - Susan Murphy
- c Institute for Social Research , University of Michigan.,d Department of Statistics, Department of Psychiatry
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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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Davey CG, Chanen AM, Cotton SM, Hetrick SE, Kerr MJ, Berk M, Dean OM, Yuen K, Phelan M, Ratheesh A, Schäfer MR, Amminger GP, Parker AG, Piskulic D, Harrigan S, Mackinnon AJ, Harrison BJ, McGorry PD. The addition of fluoxetine to cognitive behavioural therapy for youth depression (YoDA-C): study protocol for a randomised control trial. Trials 2014; 15:425. [PMID: 25370185 PMCID: PMC4230740 DOI: 10.1186/1745-6215-15-425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the Youth Depression Alleviation–Combined Treatment (YoDA-C) study is to determine whether antidepressant medication should be started as a first-line treatment for youth depression delivered concurrently with psychotherapy. Doubts about the use of medication have been raised by meta-analyses in which the efficacy and safety of antidepressants in young people have been questioned, and subsequent treatment guidelines for youth depression have provided only qualified support. Methods/Design YoDA-C is a double-blind, randomised controlled trial funded by the Australian government’s National Health and Medical Research Council. Participants between the ages of 15 and 25 years with moderate to severe major depressive disorder will be randomised to receive either (1) cognitive behavioural therapy (CBT) and fluoxetine or (2) CBT and placebo. The treatment duration will be 12 weeks, and follow-up will be conducted at 26 weeks. The primary outcome measure is change in the Montgomery-Åsberg Depression Rating Scale (MADRS) after 12 weeks of treatment. The MADRS will be administered at baseline and at weeks 4, 8, 12 and 26. Secondary outcome measures will address additional clinical outcomes, functioning, quality of life and safety. Trial registration Australian and New Zealand Clinical Trials Registry ID: ACTRN12612001281886 (registered on 11 December 2012)
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Affiliation(s)
- Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia.
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Kuhn ES, Laird RD. Family support programs and adolescent mental health: review of evidence. Adolesc Health Med Ther 2014; 5:127-42. [PMID: 25177156 PMCID: PMC4096456 DOI: 10.2147/ahmt.s48057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Family support programs aim to improve parent wellbeing and parenting as well as adolescent mental and behavioral health by addressing the needs of parents of adolescents experiencing or at risk for mental health problems. Family support programs can be part of the treatment for adolescents diagnosed with mental or behavioral health problems, or family support programs can be delivered as prevention programs designed to prevent the onset or escalation of mental or behavioral health problems. This review discusses the rationale for family support programs and describes the range of services provided by family support programs. The primary focus of the review is on evaluating the effectiveness of family support programs as treatments or prevention efforts delivered by clinicians or peers. Two main themes emerged from the review. First, family support programs that included more forms of support evidenced higher levels of effectiveness than family support programs that provided fewer forms of support. Discussion of this theme focuses on individual differences in client needs and program adaptions that may facilitate meeting diverse needs. Second, family support prevention programs appear to be most effective when serving individuals more in need of mental and behavioral health services. Discussion of this theme focuses on the intensity versus breadth of the services provided in prevention programs. More rigorous evaluations of family support programs are needed, especially for peer-delivered family support treatments.
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Affiliation(s)
- Emily S Kuhn
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
| | - Robert D Laird
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
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Gordon M, Melvin GA. Prescribing for depressed adolescents: office decision-making in the face of limited research evidence. J Paediatr Child Health 2014; 50:498-503. [PMID: 24617419 DOI: 10.1111/jpc.12517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Gordon
- Child and Adolescent Stream, Early in Life Mental Health Service, Monash Medical Centre, Melbourne, Victoria, Australia
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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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Picouto MD, Braquehais MD. Use of antidepressants for major depressive disorder in children and adolescents: clinical considerations. Int J Adolesc Med Health 2014; 25:213-9. [PMID: 23846134 DOI: 10.1515/ijamh-2013-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 08/18/2012] [Indexed: 11/15/2022]
Abstract
Major depressive disorder (MDD) is a frequent condition among children and, especially, among adolescents. However, its clinical presentation usually differs from that of adults. It is also associated with other diagnoses and with an increased morbidity and mortality. However, MDD in this population remains underrecognized and undertreated. Antidepressants (ATDs) are chosen when psychoeducational, psychosocial and/or psychotherapeutic approaches have failed. ATDs are generally used in severe cases, and are always combined with psychological treatments. The objective of this work is to discuss the role of ATD in child and adolescent MDD. We focus on the recommendations of the most cited and updated clinical guidelines and discuss some controversial aspects with regards efficacy and safety issues that have been raised based on the information obtained from clinical trials. Finally, we offer some practical recommendations for clinicians. All these findings also pose some doubt on the hypothesis of MDD as a homogeneous phenomenon during the human life cycle.
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Khatoon H. Case study of depression with substance abuse: intervention-based cognitive behavioural therapy in an outpatient setting. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2014. [DOI: 10.1080/21507686.2013.842603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zu S, Xiang YT, Liu J, Zhang L, Wang G, Ma X, Kilbourne AM, Ungvari GS, Chiu HFK, Lai KYC, Wong SYS, Yu DSF, Li ZJ. A comparison of cognitive-behavioral therapy, antidepressants, their combination and standard treatment for Chinese patients with moderate-severe major depressive disorders. J Affect Disord 2014; 152-154:262-7. [PMID: 24140226 DOI: 10.1016/j.jad.2013.09.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/26/2013] [Accepted: 09/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND No study has examined the effect of cognitive-behavioral therapy (CBT) on moderate-severe major depressive disorders (MDD) in China. The objective of this study was to evaluate the effect of CBT, antidepressants alone (MED), combined CBT and antidepressants (COMB) and standard treatment (ST; i.e., receiving psycho-educational intervention and/or medication treatment determined by treating psychiatrists) on depressive symptoms and social functioning in Chinese patients with moderate-severe MDD. METHOD A total of 180 patients diagnosed with MDD according to ICD-10 were randomly allocated to one of the four treatment regimens for a period of 6 months. Depressive symptoms were measured using the Hamilton Rating Scale for Depression (HAMD) and the Quick Inventory of Depressive Symptomatology-Self-Report (C-QIDS-SR). Remission threshold was defined as a C-QIDS-SR total score of <5. Social functioning was evaluated with the Work and Social Adjustment Scale (WSAS). All outcome measures were evaluated at entry, and at 3- and 6-months follow-up. RESULTS At the 6-months assessment, the remission rates in the whole sample (n=96), the MED, the CBT, the COMB and the ST groups were 54.2%, 48%, 75%, 53.5% and 50%, respectively. Following the treatment periods, there was no significant difference in any of the study outcomes between the four groups. However, the CBT showed the greatest effect in the HAMD total score with the effect size=0.94, whereas the ST has only a moderate effect size in the WSAS total score (effect size=0.47). CONCLUSIONS The findings support the feasibility and effectiveness of CBT as a psychosocial intervention for Chinese patients with moderate-severe MDD. We also found that single treatment using MED or CBT performed equally well as the combined CBT-antidepressant treatment in controlling the remission. The study provided important knowledge to inform the mental health care planning in China.
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Affiliation(s)
- Si Zu
- Beijing Anding Hospital, Capital Medical University, Beijing, China
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Donaldson AE, Gordon MS, Melvin GA, Barton DA, Fitzgerald PB. Addressing the Needs of Adolescents with Treatment Resistant Depressive Disorders: A Systematic Review of rTMS. Brain Stimul 2014; 7:7-12. [DOI: 10.1016/j.brs.2013.09.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Psychotherapy, Pharmacotherapy, and Their Combination for Adolescents with Major Depressive Disorder: A Meta-Analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1017/edp.2013.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This meta-analysis aims to inform clinical practice of treatment strategies for adolescents with major depressive disorder (MDD). The efficacy of three empirically validated treatments was compared to determine the most effective treatment. These were: cognitive-behavioural therapy (CBT), selective serotonin reuptake inhibitor (SSRI) pharmacotherapy, and combination CBT and SSRI therapy. Inclusion criteria required studies to report a reliable and valid pre- and post-treatment measure and adequate data for Hedge's g effect size to be calculated. Forty-nine studies meeting the above inclusion criteria were found and included in the analysis. Although all three treatment strategies were found to be effective, analysis revealed no significant difference in treatment outcome among CBT, SSRI, and combination therapy. An investigation of moderator variables revealed months to follow-up to significantly influence the relationship between treatment type and treatment outcome. Given that CBT has no side effects, is more cost effective, and is equally as effective as SSRI therapy and combination therapy, the current study makes a strong case for CBT as a first-line treatment strategy for adolescents with MDD.
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Melvin GA, Dudley AL, Gordon MS, Ford S, Taffe J, Tonge BJ. What happens to depressed adolescents? A follow-up study into early adulthood. J Affect Disord 2013; 151:298-305. [PMID: 23829999 DOI: 10.1016/j.jad.2013.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/27/2013] [Accepted: 06/10/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study describes the mental illness and psychosocial outcomes of adolescents who experienced a depressive disorder and identifies predictors of full remission and recurrence. METHODS 140 adolescents with major depressive disorder, dysthymic disorder, or depressive disorder NOS were offered psychosocial and/or antidepressant treatment across two clinical trials. Three to nine years later (mean 5.7 years), 111 adolescents and young adults completed self-, parent- and clinician-reported measures of psychopathology and psychosocial functioning in a naturalistic follow-up study. The Structured Clinical Interview for DSM-IV Axis 1 Disorders was used to determine the presence or absence of depressive disorder as well as other Axis 1 Disorders. RESULTS By the follow-up assessment, most adolescents made a full remission from their index depressive disorder (92.6%). Recurrence of depressive disorder (52.4%) during the follow-up period was common, as was the experience of other disorders including anxiety, substance abuse and eating disorders. Time to full remission and recurrence did not vary between baseline types of depressive disorder. Self-reported depressive symptoms and anxiety disorder were associated with failure to achieve full remission while socio-economic status, self-reported self-efficacy and depressive symptoms were associated with recurrence of depressive disorder. LIMITATIONS Due to different treatment starting times, the length of the follow up period varied by up to 5.2 years. CONCLUSIONS Adolescents who experience depressive disorder are at high risk of ongoing mental illness and psychosocial impairment. Predictors of the course of depressive disorder may be of use in determining which adolescents may require more intensive intervention.
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Affiliation(s)
- Glenn A Melvin
- Centre for Developmental Psychiatry and Psychology, School of Psychology & Psychiatry, Monash University, Australia.
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The relation between dosage, serum concentrations, and clinical outcome in children and adolescents treated with sertraline: a naturalistic study. Ther Drug Monit 2013; 35:84-91. [PMID: 23318280 DOI: 10.1097/ftd.0b013e31827a1aad] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This naturalistic therapeutic drug monitoring (TDM) study aimed to evaluate the relationship between dosage, serum concentration, and clinical outcome in children and adolescents treated with the serotonin reuptake inhibitor sertraline for different indications. METHODS Steady-state trough serum concentrations were analyzed in 90 subjects, treated with 25-200 mg sertraline per day. Therapeutic efficacy was assessed by the Clinical Global Impression Improvement subscale and side effects by the Udvalg for Kliniske Undersogelser-Side Effect Rating Scale. RESULTS In the study population, children were administered higher body weight normalized daily doses than adolescents. The relationships between sertraline daily dosage and serum concentrations (rs = 0.67, P < 0.0001) as well as between body weight normalized daily doses and serum concentrations (r = 0.62, P < 0.0001) were linear. In the whole patient group, no correlation between serum concentrations and either the therapeutic effect or side effects could be observed, neither significant effects of gender, age, concomitant medications, or smoking habits. When analyzing just the patients with depression, those with side effects had significantly higher sertraline serum concentrations than those without (44.8 ng/mL versus 22.3 ng/mL, P = 0.01). In general, occurrence of side effects was significantly more frequent in patients with psychiatric comedication (37.9%) than those without (11.5%, P = 0.002). DISCUSSION As this study has the typical limitations of naturalistic studies, the results should be interpreted cautiously. From the data, it is not possible to suggest an age-specific therapeutic window for children and adolescents. However, as the intraindividual variability of sertraline serum concentrations is known to be low, TDM may certainly help to predict serum concentrations after dose adjustment, to assess pharmacokinetic drug-drug interactions influencing serum concentrations and the patient's compliance, finally allowing for personalizing dose through TDM.
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Gearing RE, Schwalbe CSJ, Lee R, Hoagwood KE. The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders. Depress Anxiety 2013; 30:800-8. [PMID: 23596102 DOI: 10.1002/da.22118] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 03/11/2013] [Accepted: 03/22/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To investigate the effects of booster sessions in cognitive behavioral therapy (CBT) for children and adolescents with mood or anxiety disorders, whereas controlling for youth demographics (e.g., gender, age), primary diagnosis, and intervention characteristics (e.g., treatment modality, number of sessions). METHODS Electronic databases were searched for CBT interventions for youth with mood and anxiety disorders. Fifty-three (k = 53) studies investigating 1,937 youth met criteria for inclusion. Booster sessions were examined using two case-controlled effect sizes: pre-post and pre-follow-up (6 months) effect sizes and employing weighted least squares (WLSs) regressions. RESULTS Meta-analyses found pre-post studies with booster sessions had a larger effect size r = .58 (k = 15; 95% CI = 0.52-0.65; P < .01) than those without booster sessions r = .45 (k = 38; 95% CI = 0.41-0.49; P < .001). In the WLS regression analyses, controlling for demographic factors, primary diagnosis, and intervention characteristics, studies with booster sessions showed larger pre-post effect sizes than those without booster sessions (B = 0.13, P < .10). Similarly, pre-follow-up studies with booster sessions showed a larger effect size r = .64 (k = 10; 95% CI = 0.57-0.70; P < .10) than those without booster sessions r = .48 (k = 20; 95% CI = 0.42-0.53; P < .01). Also, in the WLS regression analyses, pre-follow-up studies showed larger effect sizes than those without booster sessions (B = 0.08, P < .01) after accounting for all control variables. CONCLUSIONS Result suggests that CBT interventions with booster sessions are more effective and the effect is more sustainable for youth managing mood or anxiety disorders than CBT interventions without booster sessions.
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Affiliation(s)
- Robin E Gearing
- Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA.
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Abstract
Major depressive disorder (MDD) in children and adolescents is a public health problem that requires evidence-based management. Our objective is to review available studies, with a PubMed search, and briefly summarize safety and efficacy results of (mostly SSRI) antidepressants in children and adolescents with MDD. Fluoxetine and escitalopram are safe and effective in the treatment of MDD in children and adolescents both in reduction of symptoms, and in remission/response rates. However, response rates are lower than for non-OCD anxiety. Sertraline also had positive results in one study that pooled results from two studies. The number needed to treat (NNT) for MDD is 10, and the number needed to harm (NNH) for suicidality is 112. Methodological limitations in the studies include, mainly, high placebo response rates, associated with multiple study sites, younger patients, and lower MDD severity. Treatment should be maintained close to 1 year after remission, to prevent relapse. FDA-approved fluoxetine and escitalopram are safe and effective in the treatment of pediatric MDD. Sertraline also has some data supporting its efficacy and safety, but is not FDA-approved. The possible modest increase in suicidal ideation in some patients should be known by clinicians, but the risk/benefit ratio is 1 to 11.2 times favorable to using SSRIs in moderate to severe MDD.
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Manglick M, Rajaratnam SM, Taffe J, Tonge B, Melvin G. Persistent sleep disturbance is associated with treatment response in adolescents with depression. Aust N Z J Psychiatry 2013; 47:556-63. [PMID: 23508680 DOI: 10.1177/0004867413481630] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sleep disturbances are highly prevalent in adolescents with depressive disorders. To date there is limited evidence of the extent to which sleep disturbances are associated with treatment response in adolescents. This study aimed to examine the extent to which self-reported sleep disturbances are associated with treatment response in adolescents with depression. METHOD Sleep data were gathered from a sample of 166 adolescents (aged 12-18 years) with a diagnosis of a DSM-IV depressive disorder who underwent 3 months of treatment (psychosocial and/or pharmacotherapy (sertraline)) in community-based research programs. The subjective report of sleep disturbance within depressive disorders was assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children at three time points: pre-treatment, post-treatment and 6-month follow-up. RESULTS Sixty-nine percent of participants had a sleep disturbance pre-treatment and approximately 75% of these participants had threshold symptoms. Threshold sleep disturbances that persisted from pre- to post-treatment assessments were positively associated with depression at the 6-month follow-up. An ordered logistic regression model controlling for gender, treatment group and comorbid anxiety estimated a 70% risk of depression or partial remission for those with persistent sleep disturbance. Treatment group, anxiety and gender generally had no significant effect on the relationship between sleep and depression. CONCLUSION Sleep disturbances were highly related to depressive state and were associated with poorer treatment response in adolescents with depression. These results provide a rationale for further exploration of sleep-related treatments for adolescents with depression. Knowledge of patient-reported persistent sleep disturbances can help clinicians to predict treatment outcomes and may direct them to augment treatment or focus on sleep-related treatment strategies.
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Affiliation(s)
- Maneesha Manglick
- Centre for Developmental Psychiatry and Psychology, School of Psychology and Psychiatry, Monash University, Notting Hill, Australia.
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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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