The Course of Major Depressive Disorder in Adolescents: I. Recovery and Risk of Manic Switching in a Follow-up of Psychotic and Nonpsychotic Subtypes

Strober, Michael; Lampert, Carlyn; Schmidt, Susan Y.; Morrell, Wendy

doi:10.1097/00004583-199301000-00006

Cited by 187 publications

(82 citation statements)

References 28 publications

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“…Other studies have also reported the presence of protracted depression in 6% to 10% of depressed children and adolescents. 25,26,[60][61][62] Consistent with the literature, [1][2][3][4][5][6][7][8]27 initial severity, failure to respond to treatment, and presence of ongoing self-reported parent-child conflict predicted persistent depression. Therefore, the presence at baseline and at the end of acute treatment of a cluster of these risk factors should alert the clinician and parents to the possibility of a more long-term course and may provide the clinician with a strategy for altering this course for the better.…”

Section: Commentsupporting

confidence: 62%

Clinical Outcome After Short-term Psychotherapy for Adolescents With Major Depressive Disorder

Birmaher

Brent²,

Kolko³

et al. 2000

Arch Gen Psychiatry

345

229

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Section: Commentsupporting

confidence: 62%

Clinical Outcome After Short-term Psychotherapy for Adolescents With Major Depressive Disorder

Birmaher

Brent²,

Kolko³

et al. 2000

Arch Gen Psychiatry

345

229

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“…However, studies indicate that a substantial proportion (up to approx. 30%) of children with depression are likely to develop bipolar disorder as they grow up [69,70] , and thus, children with a current diagnosis of bipolar disorder are not excluded from our study. Diagnosis in this study was based on semistructured psychiatric interviews conducted with the child (about him/herself) and with a parent (about the child), using the Interview Schedule for Children and Adolescents, diagnostic version (ISCA-D), which is an extension and modification of the ISCA [71] .…”

Section: Subjectsmentioning

confidence: 99%

Cytokine Genes TNF, IL1A, IL1B, IL6, IL1RN and IL10, and Childhood-Onset Mood Disorders

et al. 2008

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Background/Aims: Inflammatory cytokines induce a behavioral syndrome, known as sickness behavior, that strongly resembles symptoms typically seen in depression. This resemblance has led to the theory that an imbalance of inflammatory cytokine activity may be a contributing factor in depressive disorders. Support for this is found in multiple lines of evidence, such as the effects of cytokines on the activities of the hypothalamic-pituitary-adrenal axis, serotonin and brain-derived neurotrophic factor, and hippocampal function, all of which are implicated in the etiology of depression. In addition, associations between inflammatory activity and depressive symptomology have been documented in a number of studies, and the depressogenic effects of cytokine therapy are well known. Accordingly, given that depression has a substantial genetic basis, genes involved in the regulation of inflammatory cytokine activity are strong candidates for involvement in genetic susceptibility to depressive disorders. Here, we have tested 6 key genes of this type, TNF, IL1A, IL1B, IL6, IL1RN and IL10, as candidates for involvement in childhood-onset mood disorders. Methods: In this study of 384 families, each ascertained through a child with depression diagnosed before the age of 15 years, 11 polymorphisms of known or likely functional significance (coding and regulatory variants) were analyzed. Results: Testing for biased transmission of alleles from parents to their affected offspring, we found no evidence for an association between childhood-onset mood disorders and any of the polymorphisms, either individually or as haplotypes. Conclusion: The present study does not support the involvement of the TNF, IL1A, IL1B, IL6, IL1RN and IL10 variants as major genetic risk factors contributing to early-onset mood disorders.

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“…The mean duration of a depressive episode in youth is 32 weeks (SD=28weeks), with age of onset having an inverse relationship to time to recovery [2]. In 10% of depressed adolescents, the depressive episode lasted more than 2 years [7]. Within 5 years of the initial diagnosis, 72% of depressed youth developed recurrence [3].…”

Section: Course Of Illnessmentioning

confidence: 99%

“…Major depressive disorder in youth is associated with significant mortality by suicide [1], protracted course of illness [2], high risk of recurrence [3], significant nonresponse to treatment [4,5], progression to bipolar disorder within 5 years [6][7][8], and high frequency of affective illness in family members [9]. Even with the gold standard treatment with an SSRI and concurrent cognitive behavioral therapy, 30% to 40% will not respond to treatment, thus classified as "treatment-resistant" [5,10,11].…”

mentioning

confidence: 99%

Treatment-Resistant Depression in Adolescents: A Comprehensive Review

Carandang¹

2013

J Depress Anxiety

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disorder due to a general medical condition (including substanceinduced depression). Detailed information on the clinical assessment of children and adolescents with depression can be found elsewhere [13]. Other Factors Associated with Poor Treatment ResponseOther than the correct diagnosis of depression, clinicians should explore other factors which contribute to poor treatment response. Exploring other factors leading to treatment-resistant depression will also guide why a patient is not responding. Depressed adolescent patients with a history of abuse, especially physical abuse, had a poorer response to combination treatment with medication and psychotherapy [14]. These patients with a history of abuse may require specialized treatment. Adolescents with treatment-resistant depression had better treatment response if substance abuse-related impairment was low at baseline or reduced during treatment [15]. Suicidal adverse events during treatment of adolescent refractory depression were predicted by high suicidal ideations, family conflict and drug abuse at baseline. These predictors of suicidal adverse events also predict poor treatment response, and hence targeting suicidal ideations, family conflict and drug abuse can improve treatment outcomes [16]. Parent-child conflict has a bidirectional relationship with treatment outcome in adolescent treatment resistant depression [17]. Anhedonia in depressed adolescent's refractory to medication treatment predicted longer time to remission and fewer depression-free days [18]. Depression severity and subsyndromal manic symptoms predicted poor treatment response in this sample [19]. There is also suggestion that adjunctive sleep medication to SSRI treatment in this sample may be associated with poor response [20]. Interestingly, if treatment ends during school summer break, AbstractTreatment nonresponse in adolescent depression is a major public health problem, as untreated depression is associated with significant mortality by suicide, protracted course of illness, and recurrence into adulthood. Even with the gold-standard treatment with a Selective Serotonin Reuptake Inhibitor (SSRI) and concurrent Cognitive Behavioral Therapy (CBT), 30% to 40% will not respond to treatment, thus classified as "treatment-resistant". These depressed adolescent patients who are refractory to first-line treatments are often in such mental anguish that they are not functioning, and some have considered their only option left to end the misery is to suicide. These are the patients who are often referred to psychiatry, but the treatment options for adolescents with treatment-resistant depression are limited due to lack of research in this area. This review will consider the various treatment options that may help to alleviate the suffering of adolescents afflicted with this devastating illness, with the caveat that there are few controlled studies focused on refractory depression in adolescents.

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The Course of Major Depressive Disorder in Adolescents: I. Recovery and Risk of Manic Switching in a Follow-up of Psychotic and Nonpsychotic Subtypes

Cited by 187 publications

References 28 publications

Clinical Outcome After Short-term Psychotherapy for Adolescents With Major Depressive Disorder

Clinical Outcome After Short-term Psychotherapy for Adolescents With Major Depressive Disorder

Cytokine Genes <i>TNF</i>, <i>IL1A</i>, <i>IL1B</i>, <i>IL6</i>, <i>IL1RN</i> and <i>IL10</i>, and Childhood-Onset Mood Disorders

Treatment-Resistant Depression in Adolescents: A Comprehensive Review

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