A risk-benefit assessment of pharmacotherapies for clinical depression in children and adolescents

Child and adolescent major depressive disorders are common and recurrent disorders. The prevalence of major depressive disorders is estimated to be approximately 2% in children and 4 to 8% in adolescents. Major depressive disorders in children are frequently accompanied by other psychiatric disorders, poor psychosocial outcome and a high risk of suicide and substance abuse, indicating the need for effective treatment and prevention. The use of antidepressant medications as the first line of treatment for children and adolescents with mild to moderate major depressive disorders has been questioned. However, some subgroups of patients may benefit from initial treatment with antidepressants. These subgroups may include patients who are unwilling or unable to undergo psychotherapy, have not responded to at least 8 to 12 sessions of psychotherapy, have bipolar, atypical or severe depression or have recurrent depression. Currently, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are the first medication choice because of their efficacy, benign adverse effect profile, ease of use and low risk of death following an overdose. Further research in continuation and maintenance treatments, treatment of comorbid conditions, subtypes of depression, e.g. bipolar, atypical, seasonal, and combinations of pharmacotherapy and psychotherapy are needed. In addition, studies of the pharmacokinetics, pharmacodynamics and long term adverse effects of antidepressant medications in children and adolescents are warranted.     

Cognitive attributes of depression in children and adolescents.

This study explores whether cognitive attributes differentiate depressed children from those with other psychiatric disorders. The subjects were 108 children from 7 to 17 years of age. Forty-seven children were diagnosed as currently depressed, 30 as having had an episode of major depression within the last year (depressed-resolved), and 31 with diagnoses other than depression (nondepressed). The subjects completed the Piers-Harris Children's Self-Concept Scale, the Children's Hopelessness Scale, the Nowicki-Strickland Children's Locus of Control Scale, the Children's Attributional Styles Questionnaire, and the Children's Depression Inventory. The depressed children endorsed significantly lower self-esteem, more hopelessness, a more externalized locus of control, and a more depressive attributional style than the depressed-resolved or the nondepressed children. Thus, a depressive cognitive style can be documented in clinically depressed young people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of depression in children and adolescents.

In recent decades, research on child and adolescent depression has proliferated. Currently, attention in the field is directed toward examining the epidemiology, causes, course, sequelae, and treatment response of children at risk for developing or presently experiencing depressive disorders. In this article, a developmental psychopathology approach is used to elucidate the development of depressive disorders, the diverse pathways that evolve, and the processes that contribute to varied outcomes. The developmental psychopathology perspective underscores the importance of moving beyond the identification of isolated aberrations in psychological and biological components of depressive presentations to the understanding of how those components have evolved and how they are integrated within and transact across biological, psychological, and social systems. Implications for prevention and intervention are addressed as is the importance of increasing the public awareness of depressive disorders and reducing the social stigma that interfere with the attainment of treatment for depressed persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Components of respiratory depression after narcotic premedication in adolescents

The biliary and urinary excretion and the choleretic effect of ioglycamide were studied in unanesthetized bile fistula dogs using stepwise increasing infusion rates to obtain multiple steady states. The results are compared with data from previously reported experiments in the same animals using iodoxamate and iodipamide. The rate of biliary excretion and the choleretic effect of ioglycamide are similar to those of iodipamide and iodoxamate. Like iodipamide and iodoxamate, the relation between infusion rate or plasma concentration and biliary excretion or concentration of ioglycamide are hyperbolic and can be fitted to saturation kinetics. Quantitatively, the excretion of ioglycamide and iodipamide are virtually identical. However, for any equimolar infusion rate or plasma concentration, more iodoxamate than ioglycamide is excreted in the bile. Despite the greater biliary excretion of iodoxamate, the maximum biliary concentration of ioglycamide, iodipamide, and iodoxamate is the same at low basal bile flow because the choleretic effects of the three compounds are equal. The data suggest that, theoretically, with any equimolar dose ioglycamide will be identical to iodipamide as a contrast material for intravenous cholangiography, but that iodoxamate may be superior to ioglycamide because more iodoxamate is excreted in the bile. This advantage of iodoxamate might become apparent clinically in patients with high basal bile flow or if smaller doses of the contrast material are used. However, at the presently recommended doses of the two compounds, it is unlikely that the use of ioglycamide for intravenous cholangiography will be any different than iodoxamate.     

Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of anxiety and depression in children and adolescents.

Anxiety and depression in children and adolescents are reviewed, including differential diagnosis, assessment of symptoms, family history data, developmental features, and clinical correlates. Findings indicate that 15.9% to 61.9% of children identified as anxious or depressed have comorbid anxiety and depressive disorders and that measures of anxiety and depression are highly correlated. Family history data are inconclusive. Differences emerged among children with anxiety, depression, or both disorders. Anxious children were distinguishable from the other 2 groups in that they showed less depressive symptomatology and tended to be younger. The concurrently depressed and anxious group tended to be older and more symptomatic. In this group, the anxiety symptoms tended to predate the depressive symptoms. Findings are discussed in the context of a proposed developmental sequence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of depression in adolescents using the Center for Epidemiologic Studies Depression Scale.

Operating characteristics of the Center for Epidemiologic Studies Depression Scale (CES-D) were examined by using data from 4 samples of students in Grades 9–12. The CES-D was found to have good internal consistency and test–retest reliability. Dimensionality was comparable to that found for adults. Structure varied little by order of assessment (Trial 1 of Trial 2), age, or gender. Salience of items, in terms of rank order of mean item scores, was remarkably similar to that reported for college and general adult samples. With the standard cutoff score of 16 or more, half of the high school students were classified as depressed. There was a pronounced gender effect, with proportionately more women reporting depressive symptoms across the 4 samples. Although it appears that the CES-D scale may be appropriate for use with adolescents, the issues of stability of scores over time, appropriate cutoff scores, and usefulness in detecting cases of clinical depression remain unresolved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents.

This study evaluated the efficacy of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) with depressed adolescents in Puerto Rico. Seventy-one adolescents meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria for a diagnosis of depression were randomly assigned to 1 of 3 conditions: CBT, IFT, or wait list (WL). Pretreatment, posttreatment, and 3-month follow-up measures of depression symptoms, self-esteem, social adjustment, family emotional involvement and criticism, and behavioral problems were completed. Results suggest that IPT and CBT significantly reduced depressive symptoms when compared with the WL condition. IPT was superior to the WL condition in increasing self-esteem and social adaptation. Clinical significance tests suggested that 82% of adolescents in IPT and 59% of those in CBT were functional after treatment. The results suggest that both IPT and CBT are efficacious treatments for depressed Puerto Rican adolescents. IPT's impact in other levels of outcome is discussed in terms of its consonance with Puerto Rican cultural values. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective relations between rejection and depression in young adolescents.

The purpose of this longitudinal study was to examine the relations between rejection and depression across 3 years in young adolescents who varied with regard to their risk for depression. The sample consisted of 240 adolescents who were assessed in grades 6, 7, and 8. The assessment of rejection was based on adolescent-, mother-, and teacher-report, and depression assessment was based on adolescent- and mother-report and clinician ratings. Structural equation modeling indicated that rejection prospectively predicted depression. The authors did not find that depression prospectively predicted rejection, but such a relation cannot be ruled out because of strong cross-sectional correlations between depression and rejection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation between anxiety sensitivity and depression in children and adolescents referred for anxiety

Research conducted with adult samples suggests that anxiety sensitivity is positively related to depression (Otto et al., 1995, Journal of Anxiety Disorders, 10, 117-123). The Childhood Anxiety Sensitivity Index (CASI, Silverman et al., 1991, Journal of Clinical Child Psychology, 20 162-168) was used in this study to provide an examination of the relation between anxiety, anxiety sensitivity, and depression in a sample of children and adolescents (N = 234) referred for anxiety disorders. A significant correlation between depression and anxiety sensitivity was found. This relation remained statistically significant when controlling for other aspects of anxiety (i.e. worry, physiological anxiety, and concentration). The similarities between these findings and findings obtained with adults are discussed, as well as suggestions for future research.     

A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents.

30 moderately depressed high school students were randomly assigned to either cognitive-behavioral treatment, relaxation training, or a wait-list control condition. Treatment Ss met in small groups for 10 50-min sessions over 5 wks in a high school setting. Outcome measures included a modified Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the State-Trait Anxiety Inventory. The cognitive-behavioral and relaxation training groups were superior to the wait-list control group in the reduction of depressive symptoms at both posttest and 5-wk follow-up assessments. There was no significant difference between active treatments in their effectiveness for reducing depression. Ss in the cognitive-behavioral and relaxation training conditions went from moderate levels of depression at pretest to nondepressed levels at posttest, and they maintained these levels at follow-up. Improvements in anxiety and academic self-concept were also demonstrated by the active treatments. Findings demonstrate that these short-term group-administered therapies are effective in significantly decreasing depression in adolescents. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive bias and depression in psychiatrically disturbed children and adolescents.

Developed a cognitive bias questionnaire for children (CBQC) to examine the relation between cognitive distortion and depression in 39 psychiatrically disturbed 8–16 yr olds. Results indicate that the Depressed–Distorted scale from the CBQC was significantly correlated with Ss' psychiatric and self-reported ratings of depression and could significantly discriminate affective from nonaffective disorders. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of stress autonomy versus stress sensitization in adolescents at varied risk for depression.

This longitudinal study investigated the stress autonomy, stress sensitization, and depression vulnerability hypotheses in adolescents across 6 years (i.e., Grades 6 through 12). Participants were 240 children (Time 1 mean age = 11.86, SD = 0.57) who varied in risk for depression on the basis of their mother's history of mood disorders. All analyses were conducted as multilevel models to account for nesting in the data. Results were consistent with the stress sensitization hypothesis. The within-subject relation of stress levels to depressive symptoms strengthened with increasing numbers of prior depressive episodes. In addition, evidence consistent with the vulnerability hypothesis was found. The relation of stress levels to depressive symptoms was stronger for adolescents who were at risk for depression on the basis of maternal depression history and for those who had experienced more depressive episodes through Grade 12. These findings suggest that onsets of depression in adolescents may be predicted by both relatively stable and dynamic transactions between stressful life events and vulnerabilities such as maternal depression and youths' own history of depressive episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression-related psychosocial variables: Are they specific to depression in adolescents?

Although the psychosocial difficulties associated with adolescent depression are relatively well known, the extent to which these problems are specific to depression has received little attention. The authors examined the specificity to depression of a wide range of psychosocial variables in the following 3 groups of adolescents: depressed cases (n?=?48), nonaffective disorder cases (n?92?), and never mentally ill participants (n?=?1, 079). The authors found 3 of the 44 variables assessed in this study to be strongly specific to depression, and only the depressed participants exhibited more problematic functioning than did the never mentally ill controls. Three variables are as follows: self-consciousness, self-esteem, and a reduction in activities because of physical illness or injury. Eight variables were more strongly associated with depression than with nonaffective disorder, and 8 variables characterized both depressed and nonaffective disorder adolescents. Implications of these findings for psychosocial theories of depression are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal examination of familial risk factors for depression among inner-city African American adolescents.

This research examines longitudinally associations between family risk factors and child and parent depression in 302 urban, low-income, African American adolescents (ages 9-15) and their parents across 2 waves of data collection. Diagnostic data revealed that 7.3% of parents and 3.0% of children at Time 1 and 5.4% of parents and 2.8% of children at Time 2 were clinically depressed. Regression analyses revealed that changes in family functioning were concurrently associated with changes in depression for both children and parents. Specifically, increases in conflict and decreases in parental monitoring were associated with increases in child depressive symptomatology, and increases in conflict and decreases in positive parenting were associated with increases in parental depressive symptomatology. Findings are discussed within a framework of understanding family protective factors and the prevention of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective reciprocal relations between physical activity and depression in female adolescents.

Objective: Although an inverse correlation between physical activity and depression among adolescents has been found in research, this relation has seldom been examined prospectively. Thus, we tested whether physical activity reduces risk for future escalations in depression and whether depression decreases likelihood of future change in physical activity. Method: Data from a longitudinal study involving annual assessments of 496 adolescent girls (mean age = 13 years, SD = 0.73) followed over a 6-year period were analyzed to address these questions. Results: Using analyses that controlled for several covariates, we found that physical activity significantly reduced risk for future increases in depressive symptoms and risk for onset of major–minor depression. Further, depressive symptoms and major–minor depression significantly reduced future physical activity. However, predictive effects were modest for both. Conclusions: Results support a bidirectional relation between exercise and depression and imply that interventions that increase physical activity may reduce risk for depression among this high-risk population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of self-reported depression: Clinic-referred children versus adolescents.

The literature on childhood depression has often treated children and adolescents as a homogeneous group. However, research on cognitive and affective development suggests that the nature of depression may be different for these two age groups. We explored this possibility, separately factor analyzing Children's Depression Inventory responses for 110 clinic-referred children (aged 8–11 years) and 139 adolescents (aged 12–26 years). Although both groups produced three-factor solutions, a number of developmental differences were noted. All of the adolescent factors were correlated with parent prceptions of externalizing behavior, but none of the child factors were. Furthermore, gender differences on the factors were found for the adolescents only. An inspection of communality estimates indicated that whereas all of the CDI items were relatively involved in depression for the adolescents, only 20 of 26 items were involved for the children. Theoretical interpretation of the results was deferred pending replication of the factor structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Control-related beliefs and depression among clinic-referred children and adolescents.

Does childhood depression involve a perceived lack of control? The answer may depend on which dimension of control one examines. Here, building on recent theory, we distinguished between two dimensions: beliefs about the contingency of outcomes and beliefs about one"s own competence to perform outcome-relevant behavior. Three separate groups of clinic-referred children (aged 8–17) were sampled, one before therapy and two afterward. In all three groups, low levels of perceived competence were significantly correlated with children"s Childhood Depression Inventory (CDI) scores. Multiple regression analyses with several predictors revealed that, in each sample, competence beliefs accounted for substantial unique variance in CDI scores. In contrast, contingency beliefs were not correlated with CDI scores in any of the samples. Finally, CDI scores were consistently correlated with attributions of success and failure to "unknown"" causes. Overall, the results link childhood depression to perceived incompetence and to "contingency uncertainty,"" but not to perceived noncontingency. This suggests, in turn, that children may be more susceptible to "personal helplessness"" forms of depression than to forms identified with "universal helplessness."" (PsycINFO Database Record (c) 2010 APA, all rights reserved)