Selective serotonin reuptake inhibitors (SSRIs) for depression in children and adolescents

Hetrick, SE; Proctor, Michelle; Merry, Sally; Sindahl, Per; Ward, Anne

doi:10.1002/14651858.cd004851

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…Although the magnitude of change on the children's depression rating scale-revised was lower than that of some of the drug trials, this is to be expected given our entry criteria. Studies of antidepressants typically include young people with moderate to severe depressive disorder, 32 whereas we recruited those seeking help for depressive symptoms at a level that is typical of those who present at primary healthcare settings. 33 The New Zealand guidelines recommend that for mild to moderate depression, young people should be offered psychological therapies as preferred treatment, whereas antidepressants are recommended for those who do not respond or for those presenting with more severe depression.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial

Merry

Stasiak

Shepherd

et al. 2012

BMJ

593

530

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Objective To evaluate whether a new computerised cognitive behavioural therapy intervention (SPARX, Smart, Positive, Active, Realistic, X-factor thoughts) could reduce depressive symptoms in help seeking adolescents as much or more than treatment as usual.Design Multicentre randomised controlled non-inferiority trial.Setting 24 primary healthcare sites in New Zealand (youth clinics, general practices, and school based counselling services).Participants 187 adolescents aged 12-19, seeking help for depressive symptoms, with no major risk of self harm and deemed in need of treatment by their primary healthcare clinicians: 94 were allocated to SPARX and 93 to treatment as usual.Interventions Computerised cognitive behavioural therapy (SPARX) comprising seven modules delivered over a period of between four and seven weeks, versus treatment as usual comprising primarily face to face counselling delivered by trained counsellors and clinical psychologists.Outcomes The primary outcome was the change in score on the children's depression rating scale-revised. Secondary outcomes included response and remission on the children's depression rating scale-revised, change scores on the Reynolds adolescent depression scale-second edition, the mood and feelings questionnaire, the Kazdin hopelessness scale for children, the Spence children's anxiety scale, the paediatric quality of life enjoyment and satisfaction questionnaire, and overall satisfaction with treatment ratings.Results 94 participants were allocated to SPARX (mean age 15.6 years, 62.8% female) and 93 to treatment as usual (mean age 15.6 years, 68.8% female). 170 adolescents (91%, SPARX n=85, treatment as usual n=85) were assessed after intervention and 168 (90%, SPARX n=83, treatment as usual n=85) were assessed at the three month follow-up point. Per protocol analyses (n=143) showed that SPARX was not inferior to treatment as usual. Post-intervention, there was a mean reduction of 10.32 in SPARX and 7.59 in treatment as usual in raw scores on the children's depression rating scale-revised (between group difference 2.73, 95% confidence interval −0.31 to 5.77; P=0.079). Remission rates were significantly higher in the SPARX arm (n=31, 43.7%) than in the treatment as usual arm (n=19, 26.4%) (difference 17.3%, 95% confidence interval 1.6% to 31.8%; P=0.030) and response rates did not differ significantly between the SPARX arm (66.2%, n=47) and treatment as usual arm (58.3%, n=42) (difference 7.9%, −7.9% to 24%; P=0.332). All secondary measures supported non-inferiority. Intention to treat analyses confirmed these findings. Improvements were maintained at follow-up. The frequency of adverse events classified as "possibly" or "probably" related to the intervention did not differ between groups (SPARX n=11; treatment as usual n=11).Conclusions SPARX is a potential alternative to usual care for adolescents presenting with depressive symptoms in primary care settings and could be used to address some of the unmet demand for treatment.Trial registration Australian New...

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Section: Discussionmentioning

confidence: 99%

The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial

Merry

Stasiak

Shepherd

et al. 2012

BMJ

593

530

View full text Add to dashboard Cite

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“…A recent Cochrane meta-analysis concluded that there is very limited evidence demonstrating the relative effectiveness of antidepressant medication, psychological interventions, and a combination of these interventions in depressed youth (Cox et al, 2012). However, despite the fact that pharmacological treatments of mild to moderate adolescent MDD have not shown significant treatment effects and may introduce both short- and potential long-term negative side effects (Hetrick et al, 2007; Adegbite-Adeniyi et al, 2012), 14.1% of adolescents with primary mood disorders are treated with antidepressant medication in the U.S. (Merikangas et al, 2013). …”

Section: Introductionmentioning

confidence: 99%

The development of an RDoC-based treatment program for adolescent depression: â€œTraining for Awareness, Resilience, and Actionâ€ (TARA)

Blom

Duncan

et al. 2014

Front. Hum. Neurosci.

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Major depressive disorder (MDD) is one of the current leading causes of disability worldwide. Adolescence is a vulnerable period for the onset of depression, with MDD affecting 8–20% of all youth. Traditional treatment methods have not been sufficiently effective to slow the increasing prevalence of adolescent depression. We therefore propose a new model for the treatment of adolescent depression – Training for Awareness, Resilience, and Action (TARA) – that is based on current understanding of developmental and depression neurobiology. The TARA model is aligned with the Research Domain Criteria (RDoC) of the National Institute of Mental Health. In this article, we first address the relevance of RDoC to adolescent depression. Second, we identify the major RDoC domains of function involved in adolescent depression and organize them in a way that gives priority to domains thought to be driving the psychopathology. Third, we select therapeutic training strategies for TARA based on current scientific evidence of efficacy for the prioritized domains of function in a manner that maximizes time, resources, and feasibility. The TARA model takes into consideration the developmental limitation in top-down cognitive control in adolescence and promotes bottom-up strategies such as vagal afference to decrease limbic hyperactivation and its secondary effects. The program has been informed by mindfulness-based therapy and yoga, as well as modern psychotherapeutic techniques. The treatment program is semi-manualized, progressive, and applied in a module-based approach designed for a group setting that is to be conducted one session per week for 12 weeks. We hope that this work may form the basis for a novel and more effective treatment strategy for adolescent depression, as well as broaden the discussion on how to address this challenge.

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Exercise in prevention and treatment of anxiety and depression among children and young people

Larun

Nordheim

Ekeland

et al. 2006

Cochrane Database of Systematic Reviews

312

249

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Whilst there appears to be a small effect in favour of exercise in reducing depression and anxiety scores in the general population of children and adolescents, the small number of studies included and the clinical diversity of participants, interventions and methods of measurement limit the ability to draw conclusions. It makes little difference whether the exercise is of high or low intensity. The effect of exercise for children in treatment for anxiety and depression is unknown as the evidence base is scarce.

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Selective serotonin reuptake inhibitors (SSRIs) for depression in children and adolescents

Cited by 4 publications

References 25 publications

The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial

The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial

The development of an RDoC-based treatment program for adolescent depression: â€œTraining for Awareness, Resilience, and Actionâ€ (TARA)

Exercise in prevention and treatment of anxiety and depression among children and young people

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Selective serotonin reuptake inhibitors (SSRIs) for depression in children and adolescents

Cited by 4 publications

References 25 publications

The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial

The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial

The development of an RDoC-based treatment program for adolescent depression: â€œTraining for Awareness, Resilience, and Actionâ€ (TARA)

Exercise in prevention and treatment of anxiety and depression among children and young people

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Resources

About

The development of an RDoC-based treatment program for adolescent depression: â€œTraining for Awareness, Resilience, and Actionâ€ (TARA)