Recent developments in the treatment of major depressive disorder in children and adolescents

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.

Body weight status is not a predictive factor of depressive symptoms in Polish adolescents aged 13-18 years

“…Adolescence is known to be a demanding and critical period of life. It has been documented that the prevalence of major depression in adolescence is much greater than in childhood -3.3%-12.4%, even up to 20.0% vs. 0.4-3.0% (Bahls 2002;Hussain, Dubicka and Wilkinson 2018); in Poland it is 2-15% vs. 0.2-2% and at the age of 18, as many as 20% of adolescents had at least one depressive episode (Kołodziejek 2008;Kalinowska et al 2013). In the presented study based on adolescents aged 13-18 years, the prevalence of depression based on BDI--II was 20.2% in boys and 34.9% in girls.…”

“…Current data indicate that the prevalence of underweight adolescents in Poland va-Depression more often occurs at adolescence and has a tendency to continue to the next stages of ontogenesis (Birmaher et al 1996). Depressive symptoms are associated with many behavioural problems, increased risk for substance abuse or suicide attempts (Bahls 2002, Hussain, Dubicka andWilkinson 2018). During childhood boys are more likely to be depressed than girls, but later depression is more common in girls and this differentiation begins at the age of about 14 years (Cash and Pruzinsky, 1990;Kołodziejek 2008;Kalinowska et al 2013).…”

“…This period of dramatic physical, hormonal and cognitive changes, exposure to high levels of stress and anxiety is often linked to depressive mood or depression. When the disease is active, signs and symptoms may include: low mood (two weeks or more), sleep difficulties, weight loss or weight gain, diminished interest or pleasure, fatigue, diminished ability to think and concentrate, feelings of worthlessness, recurrent thoughts of dead, suicidal ideation, suicidal attempt or plan (Bahls 2002;Hussain, Dubicka and Wilkinson 2018). These signs and symptoms can differentiate individually but affect the functioning in all spheres of life: at home, at school and in peer and family relationships.…”

The comparative effectiveness of antidepressants for youths with major depressive disorder: a nationwide population-based study in Taiwan

“…24 Determining the most effective treatment option for youths with MDD is crucial for future clinical recommendations. 25 While previous conventional meta-analyses and network meta-analyses have produced important information regarding pharmacological treatments for depressive juveniles in the past decades, there are still several unanswered questions raised by the accumulated data of those meta-analyses. 26,27 For example, previous meta-analyses gathered data from clinical trials, which have several limitations, such as highly selected participants, fixed dosages and treatment outcomes that were only measured using rating scales during a limited study period.…”

Antidepressant withdrawal can be a horrible experience — are tapering strips a potential solution?

“…treatments that involve more individual and resource-intensive support). Use among children and adolescents is typically as a second-line treatment option for moderate to severe depression when they are unresponsive to psychological therapy and following assessment by a child and adolescent psychiatrist, but may occasionally be part of initial approaches in more severe depression (NICE, 2005;Hussain et al, 2018).…”