Introduction

  • For mild depression family physicians should first consider a trial of active support and monitoring of children and adolescents with depressive symptoms. This can include:
    • frequent follow-up visits
    • participation in extracurricular activities
    • accessing peer support groups
    • goal setting with patients and families
    • provision of educational resources. This is especially important for adolescents who refuse active treatment.1
  • Up to 20% of children and youth with depressive symptoms will respond to active support and monitoring initiatives according to RCTs. 1,2

Psychotherapy

  • Cognitive Behavioral Therapy (CBT) is the treatment of choice in mild to moderate depression; severe cases of depression may require the addition of an antidepressant.3,4
  • CBT and Interpersonal Therapy (IPT) are both effective in alleviating symptoms of depression in 12 to 18 year olds with depression; however, neither medication or psychotherapy result in high rates of remission.6
  • Both CBT and IPT have been adapted to be suitable in addressing depression in adolescents, and have demonstrated effectiveness when utilized in primary care,tertiary care, and school settings.7-9

Pharmacological Treatment

  • Fluoxetine has been proven to be safe and effective for treating adolescent depression.3,4
  • The combination of Fluoxetine and CBT is superior to either treatment used alone in reducing depressive symptoms. The use of Fluoxetine alone is superior to CBT alone.3,4
  • The combination of medication and CBT demonstrated the greatest reduction in suicidal thoughts.3,4
  • Fluoxetine (Selective Serotonin Reuptake Inhibitor or SSRI) has demonstrated the strongest evidence for efficacy in treating depression in adolescents.5

Prevention

  • Interventions for prevention of depression in children and adolescents were reviewed. This review found targeted and universal prevention programs for depression show promise in preventing the onset of depression disorders compared to no intervention.10

 

1Cheung, A.H., Zuckerbrot, R.A., Jensen, P.S., Ghalib, K., Laraque, D. et al. (2007). Guidelines for adolescent depression in primary care (GLAD-PC): II Treatment for ongoing management. Pediatrics, 120(e1313), 26.
2Goodyear, I.M., Dubicka, B., Wilkinson, P., Kelvin, R., Roberts, C. et al. (2008). A randomized controlled trial of cognitive behavior therapy in adolescents with major depression treated by selective serotonin reuptake inhibitors. The ADAPT trial. Health Technology Assessment, 12(14), iii-iv, ix-60.
3March, J., Silva, S., Petryck, S., Curry, J., Wells, K. et al. (2004). Fluoxetine, cognitive-behavioral therapy and their combination for adolescent depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. Journal of the American Medical Association, 292(7), 807-820.
4March, J., Silva, S., Petryck, S., Curry, J., Wells, K. et al. (2007). The Treatment for Adolescents with Depression Study (TADS): Long term effectiveness and safety outcomes. Archives of General Psychiatry, 64(10), 1132-1144.
5Bridge, J.A., Iyengar, S., Salary, C.B., Barbe, R.P., Binnaher, B. et al. (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials. Journal of the American Medical Association, 297, 1683-1696.
6Watanabe, N., Hunot, V., Omori, I.M., Churchill, R. & Furukawa, T.A. (2007). Psychotherapy for depression among children and adolescents: A systematic review. Acta Psychiatrica Scandinavica, 116, 84-95.
7Compton, S.N., March, J.S., Brent, D., Albano, A.M., Weersing, R. et al. (2004). Cognitive behavioural psychology for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review. Journal of the Academy of Child and Adolescent Psychiatry, 43(8), 930-959.
8Mufson, L., Weissman, M.M., Moreau, D., Garfinkel, R. (1999). Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 56, 573-579.
9Mufson, L., Dorta, K.P., Wickramaratne, P., Nomura, Y., Olfson, M. et al. (2004). A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 61, 577-584.
10Merry, S.N., Hetrick, S.E., Cox, G.R., Brudevold-Iversen, T., Bir, J.J. & McDowell, H. Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD003380. DOI: 10.1002/14651858.CD003380.pub3