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. 2006 Mar 24;12(1):44–53. doi: 10.1002/mpr.141

Child and adolescent depression: short‐term treatment effectiveness and long‐term opportunities

Neal D Ryan 1,✉
PMCID: PMC6878249  PMID: 12830309

Abstract

As with adult major depressive disorder (MDD), child and adolescent MDD is characterized as a common, chronic and recurrent disorder. It is also associated with short‐ and long‐term functional impairment, morbidity, and mortality. Effective treatments, both psychotherapeutic and pharmacotherapeutic, are available for the short‐term treatment and management of youth with MDD. However, to date, there are no data on the long‐term treatment and management of children and adolescents with MDD and how long‐term treatment may affect the outcomes of either high‐risk or already affected youth. Understanding the long‐term consequences of MDD during youth is as important as understanding how to treat a single episode of depression.

Available data on the pharmacotherapeutic and psychotherapeutic options are discussed. In general, tricyclic antidepressants (TCAs) are not as effective for the treatment of youth with MDD as adults with MDD. The selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in children and adolescents with MDD and non‐obsessive compulsive anxiety disorders. The serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine XR, has been shown to be effective for the treatment of generalized anxiety disorder in children and adolescents.

Understanding the long‐term clinical consequences of depressive disorders in youth may provide opportunities for better intervention across the clinical course of illness. Early recognition, diagnosis and adequate treatment of ‘high‐risk’ youth with subsyndromal depressive symptoms, treatment of acute episodes of depression to prevent ‘kindling’, and aggressive prophylaxis have the potential to improve the mental health of youth throughout their lives. Copyright © 2003 Whurr Publishers Ltd.

Keywords: youth, MDD, GAD, pharmacotherapy, psychotherapy

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References

  1. Angold A, Costello EJ, Erkanli A. Comorbidity. J Child Psychol Psychiatry and Allied Disciplines 1999; 40: 57–87. [PubMed] [Google Scholar]
  2. Angold A, Costello EJ, Worthman CM. Puberty and depression: the roles of age, pubertal status and pubertal timing. Psychol Med 1998; 28: 51–61. [DOI] [PubMed] [Google Scholar]
  3. Birmaher B, Brent DA, Kolko D, et al. Clinical outcome after short‐term psychotherapy for adolescents with major depressive disorder. Arch Gen Psychiatry 2000; 57: 29–36. [DOI] [PubMed] [Google Scholar]
  4. Birmaher B, Ryan ND, Williamson DE, et al. Childhood and adolescent depression: a review of the past 10 years. Part II. J Am Acad Child Adolesc Psychiatry 1996a; 35: 1575–83. [DOI] [PubMed] [Google Scholar]
  5. Birmaher B, Ryan ND, Williamson DE, et al. Childhood and adolescent depression: a review of the past 10 years. Part I. J Am Acad Child Adoles Psychiatry 1996b; 35: 1427–39. [DOI] [PubMed] [Google Scholar]
  6. Brent DA, Holder D, Kolko D, et al. A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Arch Gen Psychiatry 1997; 54: 877–85. [DOI] [PubMed] [Google Scholar]
  7. Brent DA, Perper JA, Moritz G, et al. Psychiatric risk factors for adolescent suicide: a case‐control study. J Am Acad Child Adolesc Psychiatry 1993; 32: 521–9. [DOI] [PubMed] [Google Scholar]
  8. Clarke GN, Hornbrook M, Lynch F, et al. A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Arch Gen Psychiatry 2001; 58: 1127–34. [DOI] [PubMed] [Google Scholar]
  9. Donnelly CL, Winokur A, Wohlberg CJ. Efficacy and Safety of Sertraline in the Treatment of Pediatric Major Depressive Disorder. San Juan: American College of Neuropsychopharmacology (ACNP) Hawaii, 2001. [Google Scholar]
  10. Emslie GJ, Heiligenstein JH, Hoog SL, et al. Fluoxetine for Acute Treatment of Depression in Children and Adolescents: A Placebo‐controlled, Randomized clinical Trial. San Juan: American College of Neuropsychopharmacology (ACNP), 2000. [DOI] [PubMed] [Google Scholar]
  11. Emslie GJ, Mayes TL. Mood disorders in children and adolescents: psychopharmacological treatment. Biol Psychiatry 2001; 49: 1082–90. [DOI] [PubMed] [Google Scholar]
  12. Emslie GJ, Rush A, Weinberg W, et al. A double‐blind, randomized, placebo‐controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry 1997; 54: 1031–7. [DOI] [PubMed] [Google Scholar]
  13. Fleming JE, Offord DR. Epidemiology of childhood depressive disorders: a critical review. J Am Acad Child Adolesc Psychiatry 1990; 29: 571–80. [DOI] [PubMed] [Google Scholar]
  14. Geller B, Fox LW, Clark KA. Rate and predictors of prepubertal bipolarity during follow‐up of 6‐ to 12‐year‐old depressed children. J Am Acad Child Adolesc Psychiatry 1994; 33: 461–8. [DOI] [PubMed] [Google Scholar]
  15. Harrington R, Campbell F, Shoebridge P, et al. Meta‐analysis of CBT for depression in adolescents. J Am Acad Child Adolesc Psychiatry 1998a; 37: 1005–7. [DOI] [PubMed] [Google Scholar]
  16. Harrington R, Fudge H, Rutter M, et al. Adult outcomes of childhood and adolescent depression. I. Psychiatric status. Arch Gen Psychiatry 1990; 47: 465–73. [DOI] [PubMed] [Google Scholar]
  17. Harrington R, Whittaker J, Shoebridge P. Psychological treatment of depression in children and adolescents. A review of treatment research. Br J Psychiatry 1998b; 173: 291–8. [DOI] [PubMed] [Google Scholar]
  18. Ialongo NS, Werthamer L, Kellam SG, et al. Proximal impact of two first‐grade preventive interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior. Am J Community Psychol 1999; 27: 599–641. [DOI] [PubMed] [Google Scholar]
  19. Jaffee SR, Moffitt TE, Caspi A, et al. Differences in early childhood risk factors for juvenile‐onset and adult‐onset depression. Arch Gen Psychiatry 2002; 59: 215–22. [DOI] [PubMed] [Google Scholar]
  20. Kellam SG, Rebok GW, Mayer LS, et al. Depressive symptoms over first grade and their response to a developmental epidemiologically based preventive trial aimed at improving achievement. Dev Psychopathol 1994; 6: 463–81. [Google Scholar]
  21. Keller MB, Ryan ND, Strober M, et al. Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2001; 40: 762–72. [DOI] [PubMed] [Google Scholar]
  22. Kendler KS, Kessler RC, Walters EE, et al. Stressful life events, genetic liability, and onset of an episode of major depression in women. Am J Psychiatry 1995; 152: 833–42. [DOI] [PubMed] [Google Scholar]
  23. Kendler KS, Thornton LM, Gardner CO. Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the ‘kindling’ hypothesis. Am J Psychiatry 2000; 157: 1243–51. [DOI] [PubMed] [Google Scholar]
  24. Kendler KS, Thornton LM, Gardner CO. Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression. Am J Psychiatry 2001; 158: 582–6. [DOI] [PubMed] [Google Scholar]
  25. Kessler RC, Davis CG, Kendler KS. Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychol Med 1997; 27: 1101–19. [DOI] [PubMed] [Google Scholar]
  26. Kessler RC, Walters EE. Epidemiology of DSM‐III‐R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey. Depress Anxiety 1998; 7: 3–14. [DOI] [PubMed] [Google Scholar]
  27. Klein DN, Lewinsohn PM, Seeley JR, et al. A family study of major depressive disorder in a community sample of adolescents. Arch Gen Psychiatry 2001; 58: 13–20. [DOI] [PubMed] [Google Scholar]
  28. Kovacs M, Gatsonis C. Secular trends in age at onset of major depressive disorder in a clinical sample of children. J Psychiatr Res 1994; 28: 319–29. [DOI] [PubMed] [Google Scholar]
  29. Labellarte MJ, Ginsburg GS, Walkup JT, et al. The treatment of anxiety disorders in children and adolescents. Biol Psychiatry 1999; 46: 1567–78. [DOI] [PubMed] [Google Scholar]
  30. Lewinsohn PM, Clarke GN. Psychosocial treatments for adolescent depression. Clin Psychol Rev 1999; 19: 329–42. [DOI] [PubMed] [Google Scholar]
  31. Lewinsohn PM, Klein DN, Seeley JR. Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry 1995; 34: 454–63. [PubMed] [Google Scholar]
  32. Lewinsohn PM, Rohde P, Seeley JR, et al. Age‐cohort changes in the lifetime occurrence of depression and other mental disorders. J Abnorm Psychol 1993; 102: 110–20. [DOI] [PubMed] [Google Scholar]
  33. Lewinsohn PM, Rohde P, Seeley JR. Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications. Clin Psychol Rev 1998a; 18: 765–94. [DOI] [PubMed] [Google Scholar]
  34. Lewinsohn PM, Rohde P, Seeley JR. Treatment of adolescent depression: frequency of services and impact on functioning in young adulthood. Depress Anxiety 1998b; 7: 47–52. [DOI] [PubMed] [Google Scholar]
  35. Marcus SC, Fortney JC, Olfson M, et al. Travel distance to outpatient treatment for depression. Psychiatr Serv 1997a; 48: 1005. [DOI] [PubMed] [Google Scholar]
  36. Marcus SC, Olfson M, Fortney JC, et al. Travel distance to subspecialty and general mental health services. Psychiatr Serv 1997b; 48: 775. [DOI] [PubMed] [Google Scholar]
  37. Moreau D, Mufson L, Weissman MM, et al. Interpersonal psychotherapy for adolescent depression: description of modification and preliminary application. J Am Acad Child Adolesc Psychiatry 1991; 30: 642–51. [DOI] [PubMed] [Google Scholar]
  38. Mufson L, Fairbanks J. Interpersonal psychotherapy for depressed adolescents: a one‐year naturalistic follow‐up study. J Am Acad Child Adolesc Psychiatry 1996; 35: 1145–55. [DOI] [PubMed] [Google Scholar]
  39. Mufson L, Weissman MM, Moreau D, et al. Efficacy of interpersonal psychotherapy for depressed adolescents. Arch Gen Psychiatry 1999; 56: 573–9. [DOI] [PubMed] [Google Scholar]
  40. Neuman RJ, Geller B, Rice JP, et al. Increased prevalence and earlier onset of mood disorders among relatives of prepubertal versus adult probands. J Am Acad Child Adolesc Psychiatry 1997; 36: 466–73. [DOI] [PubMed] [Google Scholar]
  41. Olfson M, Kessler RC, Berglund PA, et al. Psychiatric disorder onset and first treatment contact in the United States and Ontario. Am J Psychiatry 1998; 155: 1415–22. [DOI] [PubMed] [Google Scholar]
  42. Post RM. Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. Am J Psychiatry 1992; 149: 999–1010. [DOI] [PubMed] [Google Scholar]
  43. Puig‐Antich J, Goetz D, Davies M, et al. A controlled family history study of prepubertal major depressive disorder. Arch Gen Psychiatry 1989; 46: 406–18. [DOI] [PubMed] [Google Scholar]
  44. Puig‐Antich J, Kaufman J, Ryan ND, et al. The psychosocial functioning and family environment of depressed adolescents. J Am Acad Child Adolesc Psychiatry 1993; 32: 244–53. [DOI] [PubMed] [Google Scholar]
  45. Puig‐Antich J, Lukens E, Davies M, et al. Psychosocial functioning in prepubertal major depressive disorders. I. Interpersonal relationships during the depressive episode. Arch Gen Psychiatry 1985a. 42: 500–7. [DOI] [PubMed] [Google Scholar]
  46. Puig‐Antich J, Lukens E, Davies M, et al. Psychosocial functioning in prepubertal major depressive disorders. II. Interpersonal relationships after sustained recovery from affective episode. Arch Gen Psychiatry 1985b. 42: 511–17. [DOI] [PubMed] [Google Scholar]
  47. Rao U, Ryan ND, Birmaher B, et al. Unipolar depression in adolescents: clinical outcome in adulthood. J Am Acad Child Adolesc Psychiatry 1995; 34: 566–78. [DOI] [PubMed] [Google Scholar]
  48. Ryan ND, Puig‐Antich J, Ambrosini P, et al. The clinical picture of major depression in children and adolescents. Arch Gen Psychiatry 1987; 44: 854–61. [DOI] [PubMed] [Google Scholar]
  49. Ryan ND, Varma D. Child and adolescent mood disorders–experience with serotonin‐based therapies. Biol Psychiatry 1998; 44: 336–40. [DOI] [PubMed] [Google Scholar]
  50. Ryan ND, Williamson DE, Iyengar S, et al. A secular increase in child and adolescent onset affective disorder. J Am Acad Child Adolesc Psychiatry 1992; 31: 600–5. [DOI] [PubMed] [Google Scholar]
  51. Sallee FR, Vrindavanam NS, Deas‐Nesmith D, et al. Pulse intravenous clomipramine for depressed adolescents: double‐blind, controlled trial. Am J Psychiatry 1997; 154: 668–73. [DOI] [PubMed] [Google Scholar]
  52. Schneider EC, Zaslavsky AM, Epstein AM. Racial disparities in the quality of care for enrollees in medicare managed care. JAMA 2002; 287: 1288–94. [DOI] [PubMed] [Google Scholar]
  53. Silberg J, Pickles A, Rutter M, et al. The influence of genetic factors and life stress on depression among adolescent girls. Arch Gen Psychiatry 1999; 56: 225–32. [DOI] [PubMed] [Google Scholar]
  54. Simeon JG, Dinicola VF, Ferguson HB, et al. Adolescent depression: a placebo‐controlled fluoxetine treatment study and follow‐up. Prog Neuropsychopharmacol Biol Psychiatry 1990; 14: 791–5. [DOI] [PubMed] [Google Scholar]
  55. Thapar A, Harold G, McGuffin P. Life events and depressive symptoms in childhood–shared genes or shared adversity? A research note. J Child Psychol Psychiatry 1998; 39: 1153–8. [PubMed] [Google Scholar]
  56. Thapar A, McGuffin P. A twin study of depressive symptoms in childhood. Br J Psychiatry 1994; 165: 259–65. [DOI] [PubMed] [Google Scholar]
  57. Thapar A, McGuffin P. The genetic etiology of childhood depressive symptoms: a developmental perspective. Dev Psychopathol 1996; 1996: 751–60. [Google Scholar]
  58. Thase ME, Entsuah AR, Rudolph RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry 2001; 178: 234–41. [DOI] [PubMed] [Google Scholar]
  59. Wagner KD, Robb AS, Findling R, et al. Citalopram is Effective in the Treatment of Major Depressive Disorder in Children and Adolescents: Results of a Placebo‐controlled Trial. San Juan: American College of Neuropsychopharmacology (ACNP) Hawaii, 2001. [Google Scholar]
  60. Wagner KD, Wohlberg C. Efficacy and safety of Sertraline for treatment of pediatric major depressive disorder. American Psychiatric Association Meeting 2002; 327: 89. [Google Scholar]
  61. Walkup JT, Labellarte MJ, Riddle MA, et al. Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 2001; 344: 1279–85. [DOI] [PubMed] [Google Scholar]
  62. Weissman MM, Wickramaratne P, Merikangas KR, et al. Onset of major depression in early adulthood. Increased familial loading and specificity. Arch Gen Psychiatry 1984; 41: 1136–43. [DOI] [PubMed] [Google Scholar]
  63. Weissman MM, Wolk S, Goldstein RB, et al. Depressed adolescents grown up. JAMA 1999a; 281: 1707–13. [DOI] [PubMed] [Google Scholar]
  64. Weissman MM, Wolk S, Wickramaratne P, et al. Children with prepubertal‐onset major depressive disorder and anxiety grown up. Arch Gen Psychiatry 1999b; 56: 794–801. [DOI] [PubMed] [Google Scholar]
  65. Weissman MM. Juvenile‐onset major depression includes childhood‐ and adolescent‐onset depression and may be heterogeneous. Arch Gen Psychiatry 2002; 59: 223–4. [DOI] [PubMed] [Google Scholar]
  66. Williamson DE, Birmaher B, Frank E, et al. Nature of life events and difficulties in depressed adolescents. J Am Acad Child Adolesc Psychiatry 1998; 37: 1049–57. [DOI] [PubMed] [Google Scholar]
  67. Williamson DE, Ryan ND, Birmaher B, et al. A case‐control family history study of depression in adolescents. J Am Acad Child Adolesc Psychiatry 1995; 34: 1596–607. [DOI] [PubMed] [Google Scholar]

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