Elsevier

The Lancet

Volume 366, Issue 9489, 10–16 September 2005, Pages 933-940
The Lancet

Seminar
Treatment of depression in children and adolescents

https://doi.org/10.1016/S0140-6736(05)67321-7Get rights and content

Summary

Depressive disorders during youth occur frequently, are chronic and recurrent, and are associated with significant functional impairment, morbidity, and mortality. Two psychotherapeutic approaches—cognitive behavioural therapy and interpersonal therapy—are each better than wait-list or treatment-as-usual approaches. Several antidepressants have proven efficacious compared with placebo; however, more than half the studies comparing antidepressant treatment with placebo in children and adolescents with depression have not shown any benefit of the active compounds. Suicide rates are decreasing overall in adolescents, and there seems to be a correlation between the use of selective serotonin reuptake inhibitors (SSRIs) and a decrease in completed suicide. However, there was a signal for increase in suicide attempts and suicidal ideation in patients on acute antidepressant treatment when all antidepressants were assessed as a single group. Thus, there is substantial debate about the best approach to treat this serious disorder. Here, we discuss the treatment options for depression in children and adolescents.

Section snippets

Treatment studies

There are far fewer treatment studies of depression in children and adolescents than in adults for reasons of patient availability (there are fewer children than adults and the point prevalence of depression is lower through much of childhood), funding availability (both industry and other funding sources fund fewer child studies than adult studies), and investigator availability. Therefore, the confidence intervals for deciding whether or not the efficacy of antidepressant treatments in youth

Long-term treatment and prevention of relapse and recurrence

The rationale for continuation treatment is strong and rests on two foundations: 1) episodes of depression are bad during the episode itself, and, subsequently with suffering, increased risk of suicide, and impairment at home and school; 2) longer episodes of depression can increase the risk for future subsequent episodes—termed the kindling hypothesis.71, 72, 73 Short-term treatment does not seem to change long-term outcome after the discontinuation of treatment.74

Most youth depression

Treatment side-effects

Excluding the issue of suicidality, the side-effect profile of SSRI and other newer antidepressants seems similar in youths to that seen in adults.52, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57 Therefore, we will not discuss these other relatively common and generally readily managed side-effects. The overarching question is whether

Conclusions

We have suggested elsewhere that future improvements in the treatment of depression in youth should concentrate on secondary prevention (eg, aggressive treatment of anxiety disorders to prevent progression to depression), improved and early ascertainment, more attention to successfully keeping children in treatment for the recommended course, and more systematic and consistent application of available research findings to all youths with depression.91

Cognitive behavioural therapy and

Search strategy and selection criteria

We searched MEDLINE (2000–04) and used all material from the FDA web site. Search terms were “depressive disorder” and “childhood depression” in combination with a limit to patient age range of 6–18 years. We then limited the results using the terms “epidemiology”, “natural history”, and “treatment”. We largely selected publications in the past 5 years, but did not exclude commonly referenced and highly regarded older publications. We also searched the reference list of articles identified by

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