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Prevention and treatment of child and adolescent depression: challenges and opportunities

Part of: Special Articles

Published online by Cambridge University Press:  28 March 2011

B. Vitiello
B. Vitiello*
Affiliation:
National Institute of Mental Health, Bethesda, MD, USA
*
*Address for correspondence: Dr. B. Vitiello, National Institute of Mental Health, Room 7147, 6001 Executive Blvd., Bethesda, MD 20892-9633, USA. (Email: bvitiell@mail.nih.gov)
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Abstract

Objective.

To examine the current theoretical rationale and empirical evidence for preventing and treating major depressive disorder in childhood and adolescence.

Methods.

Selective review of recent controlled investigations on the efficacy and safety of preventive and treatment interventions.

Results.

Even more than in adults, pediatric clinical trials in depression are dominated by symptomatic improvement with non-specific clinical contact (on average, 50% ‘placebo response’). The additional benefit of specific psychotherapeutic or pharmacological treatment is on average modest. Antidepressant medication is effective in speeding up improvement, but more than a third of patients do not reach full remission even after prolonged treatment. The advantage of routinely combining medication with cognitive-behavioral therapy (CBT) is unclear. Depressed suicidal adolescents can benefit from CBT and medications. CBT can protect high-risk youths from developing a depressive episode.

Conclusions.

Effective interventions to prevent and treat depression in youth exist, but their therapeutic benefit appears to be, on average, small, possibly due to the clinical heterogeneity subsumed under the current diagnostic construct of depressive disorder. More specifically, targeted interventions tailored to individual clinical and biological characteristics may result in greater effectiveness and overall efficiency.

Keywords

depressiontreatmentpreventionchildren
Type
Special Article
Information
Epidemiology and Psychiatric Sciences , Volume 20 , Issue 1 , March 2011 , pp. 37 - 43
Copyright
Copyright © Cambridge University Press 2011. This is a work of the U.S. Government and is not subject to Copyright Protection in the United States

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