Depression

Encyclopedia of Childhood and Adolescence, Apr 06, 2001 by Boris Birmaher, M.D. and David Axelson, M.D. Department of Psychiatry University of Pittsburgh School of Medicine Western Psychiatric Institute and Clinic

It may also be important to include parents in the treatment process because: (1) children are dependent on their parents; (2) depressed youth frequently come from families with high rates of depression or high degree of conflicts; and (3) parent psychopathology and family conflict may predict a poor outcome to treatment and increase risk for depressive recurrences.

Most of the studies published so far have evaluated the effects of the tricyclic antidepressants, such as nortriptyline (brand name Pamelor), imipramine (Tofranil), desipramine (Norpramin), and the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) in treating clinical depression. The studies show that some children and adolescents benefit from these medications.

Medications for treating depression differ in some ways from medications that people take for other medical illnesses. Though some people with depression notice a reduction in symptoms in a few days, most of the time there is a delay of up to 4-6 weeks for the medications to have an effect. The symptoms of depression usually do not improve all at once, but instead show a gradual and, at times, uneven improvement. Once the depression has improved, there is evidence, at least in adults, that people with depression should keep taking medication for a period of time to prevent recurrence. Lastly, all antidepressants carry a small risk of triggering a manic or hypomanic (milder form of mania) episode in vulnerable patients. (For more information on medications, please refer to Antidepressants ).

Very few investigations of depression have addressed the prevention of relapses (reappearance of depression within two months of symptom resolution) and recurrences (a new episode of depression). After successful treatment with psychotherapy or medication, most patients have a relapse or recurrence. Therefore, to prevent relapses, it is recommended that psychotherapy and/or medication treatments continue. In adults, medication (with same dose that was used to cure the depression) may be continued for at least 16-20 weeks after achieving full remission of depressive symptom. In addition, various forms of psychotherapy can be used during the continuation period to help patients cope with the psychological and social difficulties produced by the depression and to manage the stress and conflicts that may trigger a depressive relapse or diminish medication compliance.

To prevent recurrences, the length of therapy depends on several factors, such as severity of the depression, number of depressive episodes, chronicity, presence of psychotic symptoms, other psychiatric disorders, family psychopathology, and presence of an adequate support system. In adults, three to five years of psychotherapy and/or medication can significantly reduce the occurrence of additional MDD episodes. Community studies of adolescents have shown that group cognitive-behavioral therapy combined with relaxation and group problem-solving therapy may prevent recurrences of depression for up to 9-24 months after treatment.