Adolescents depression

A more rigorous investigation of the taxonicity of adolescent depression was reported by Ambrosini, Bennett, Cleland, and Haslam (2002). This study included 378 adolescents (mean age of 15.7 years), most of whom (n = 358) were outpatients referred to a child and adolescent depression clinic the remaining 20 were inpatients. Participants were assessed with the BDI... 

H. Koplewicz, More Than Moody Recognizing and Treating Adolescent Depression (New Yotk The Betkley Publishing Group,... 

To the best of our knowledge, no studies with child and adolescent depressed cohorts have examined hippocampal volume. The one study that examined hippocampal volume in children and adolescents with PTSD (n = 43), about half of whom met criteria for comorbid MDD, failed to find evidence of hippocampal atrophy (De Beilis et ah, 1999). This finding is not surprising, as most of the children and adolescents in the study had not experienced more than one episode of depression, and hippocampal atrophy was found to be correlated with total lifetime duration of illness in the prior adult studies cited (Sheline et ah, 1996 Brem-ner et ah, 2000). Developmental factors may also account for the discrepant findings in child and adult studies. For example, age-dependent changes in sensitivity to some forms of N-methyl-D-aspartate (NMDA) receptor blockade neurotoxicity in corticolimbic regions have been reported in preclinical studies, with cell death minimal or absent prepuberty and reaching peak in early adulthood (Father et ah, 1995). 

Birmaher, B., Ryan, N.D., Williamson, D.E., Brent, D.A., and Kaufman, J. (1996b) Childhood and adolescent depression a review of the past 10 years. Part II. J Am Acad Child Adolesc Psychiatry... 

Kaufman, J., and Ryan, N. (1999) The neurobiology of child and adolescent depression. In Charney, D., Nestler, E., and Bunny, B., eds. The Neurobiological Foundation of Mental Illness. New York Oxford University Press, pp. 810-821. 

Adolescent depression a placebo-controlled fluoxetine treatment study and follow-up. Prog Neuropsychopharmacol Biol Psychiatry 4 791-795. 

Brent, D.A., Holder, D., Birmaher, B., Baugher, M., Roth, C., Iyengar, S., and Johnson, B. (1997) A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Arch Gen Psychiatry 54 877-885. 

Clarke, G.N., Hops, H., Lewinsohn, P.M., Andrews, J.A., Seeley, J.R., and Williams, J. (1992) Cognitive behavioral group treatment of adolescent depression prediction of outcome. Behav Ther 23 341-354. 

Emslie, G.J., Rush, A.J., Weinberg, W.A., Kowatch, R.A., Carmody, T., and Mayes, T.L. (1998) Fluoxetine in child and adolescent depression acute and maintenance treatment. Depress Anxiety 7 32-39. 

Simeon, J., Dinicola, V., Ferguson, H., and Copping, W. (1990) Adolescent depression a placebo-controlled fluoxetine treatment study and follow-up. Prog Neuropsychopharmacol Biol Psychiatry 14 791-795. 

Other SSRIs may be selected as an alternative to fluvoxamine in the event that fluvoxamine cannot be used. Sertraline is the first option because of efficacy for pediatric GAD (Rynn et ah, 2001) paroxetine is an option because of controlled treatment data for adolescent depression (Keller et ah, 2000) and OCD (see Chapter 39) and fluoxetine is an option because of controlled treatment data for pediatric depression (Em-slie et ah, 1997). Eorazepam is included as a short acting alternative to clonazepam. Nortriptyline, which is less anticholinergic and thus may be better tolerated, is included as an alternative to IMF... 

Kutcher, S. (1997) Practitioner review the pharmacotherapy of adolescent depression. / Child Psychol Psychiatry 38 755-767. 

Rohde, P., Clarke, G., Lewinson, P., Seeley, J., and Kaufman, N. (2001) Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression. / Am Acad Child Adolesc Psychiatry 40 795-802. 

Keller MB, Ryan NMD, Birmaher B, et al. Paroxetine and imipramine in the treatment of adolescent depression. New Research Program Abstracts, Annual Meeting of the American Psychiatric Association, Toronto, 1998. 

Kramer A, Feiguine R. Clinical effects of amitriptyline in adolescent depression. J Am Acad Child Psychiatry 1981 20 636-644. 

Kutcher S, Boulos C, Ward B, et al. Response to desipramine treatment in adolescent depression a fixed-dose, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry 1994 33 686-694. 

The UK Committee of Safety of Medicines has previously warned that paroxetine appeared to be no more effective than placebo in the treatment of depression in adolescents and might be associated with a greater risk of self harm (SEDA-28, 16). In a meta-analysis of both published and unpublished placebo-controlled trials of SSRIs in childhood and adolescent depression, only fluoxetine seemed clearly to be associated with a positive benefit-harm balance (26). The evidence of efficacy for sertraline and citalopram was doubtful, while the risk of serious adverse events was significantly increased. Additionally, for both drugs the risk of suicidal behavior was numerically increased. In regard to venlafaxine, the risk of suicidal behavior was significantly greater than placebo. 

There has been recent concern from unpublished data in industry-sponsored trials of SSRIs in child and adolescent depression suggesting that these drugs may lead to an increased rate of suicidal ideation. This prompted a review of their use by the UK Committee on Safety of Medicines (CSM) in 2003, which raled that for major depressive disorder (MDD) in children and adolescents under the age of 18 ... 

Antidepressants became a media obsession in the early 1990s largely following the publication of Prozac Nation, Elizabeth Wurtzel s memoir of adolescent depression and its unexpected cure by a new kind of antidepressant called fluoxetine, better known as Prozac. Listening to Prozac, psychiatrist Peter Kramer s best-selling book, continued the drug s run of publicity with its descriptions... 

In any case, there is a pressing need for a systematic study of adolescent depression, comparing psychotherapy or cognitive behavioral thereapy (CBT) and antidepressants, or the combination of both treatments. The National Institute of Mental Health (NIMH) has organized a multicenter study which will analyze the long-term effectiveness of Prozac versus CBT. Results of the study, called Treatment for Adolescent Depression Study (TADS), will not be published for several years, but it is hoped that the results will help resolve whether antidepressants in teens are beneficial and safe. 

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