https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60871-4.pdf

Depression in adolescence

This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice. J. Am. Acad. Child Adolesc. Psychiatry, 2007; 46(11):1503Y1526. Key Words: major depressive disorder, dysthymic disorder, evaluation, treatment, antidepressants, selective serotonin reuptake inhibitors, psychotherapy, practice parameter. Depressive disorders are often familial recurrent illnesses associated with increased psychosocial morbidity and mortality. Early identification and effective treatment may reduce the impact of depression on the family, social, and academic functioning in youths and may reduce the risk of suicide, substance abuse, and persistence of depressive disorders into adulthood. Evidencesupported treatment interventions have emerged in psychotherapy and medication treatment of childhood depressive disorders that can guide clinicians to improve outcomes in this population.

https://aacap.org/app_themes/aacap/docs/practice_parameters/depressive_disorders_practice_parameter.pdf

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability.

/pdf/effects-of-psychotherapy-for-depression-in-children-and-3oncraaelp.pdf

Effects of psychotherapy for depression in children and adolescents: a meta-analysis.

In the debate over evidence-based treatments (EBTs) for youth, one question is central: Do EBTs produce better outcomes than the usual interventions employed in clinical care? The authors addressed this question through a meta-analysis of 32 randomized trials that directly compared EBTs with usual care. EBTs outperformed usual care. Effects fell within the small to medium range at posttreatment, increasing somewhat at follow-up. EBT superiority was not reduced by high levels of youth severity or by inclusion of minority youths. The findings underscore a need for improved study designs and detailed treatment descriptions. In the future, the EBT versus usual care genre can inform the search for the most effective interventions and guide treatment selection in clinical care.

Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons.

Mindfulness meditation is a well-validated intervention for symptoms of depression and anxiety disorders in adults, with meta-analyses showing moderate effect sizes. This study marks the first published meta-analysis of the burgeoning literature on mindfulness meditation with youth (conducted between 2004 and 2011) and identifies specific outcomes and sub-populations for whom mindfulness may be particularly helpful. Inclusion criteria were peer-reviewed journal articles published in English, study participants under 18 years of age, and a description in the methods section of mindfulness as the chief component of an intervention. A systematic search was conducted, of which upon review, 20 articles met inclusion criteria. Mindfulness interventions with youth overall were found to be helpful and not to carry iatrogenic harm, with the primary omnibus effect size (del) in the small to moderate range (0.23, p < .0001), indicating the superiority of mindfulness treatments over active control comparison conditions. A significantly larger effect size was found on psychological symptoms compared to other dependent variable types (0.37 vs. 0.21, p = .028), and for studies drawn from clinical samples compared to non-clinical sample (0.50 vs. 0.20, p = .024). Mindfulness appears to be a promising intervention modality for youth. Although to date the majority of studies on mindfulness with youth engage generally healthy participants recruited from schools, the findings of this meta-analysis suggest that future research might focus on youth in clinical settings and target symptoms of psychopathology.

/pdf/mindfulness-interventions-with-youth-a-meta-analysis-4owt4tlqew.pdf

Mindfulness Interventions with Youth: A Meta-Analysis

Context: Adolescent depression is highly prevalent and has substantial morbidity, including suicide attempts, school dropout, and substance abuse, but many depressed adolescents are untreated. The school-based health clinic offers the potential for accessible and efficient treatment, although it is unknown whether school-based clinicians can be trained to implement evidence-based psychotherapies for depression in routine care. Objective: To assess the effectiveness of interpersonal psychotherapy modified for depressed adolescents (IPT-A) compared with treatment as usual (TAU) in schoolbased mental health clinics.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/482013/yoa30207.pdf

A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Adolescents

This paper presents an overview of the adaptation of Interpersonal Psychotherapy for depressed adolescents (IPT-A) to be delivered in a group format (IPT-AG) for the treatment of depressed, nonbipolar outpatient adolescents. The model has been modified to address the challenges of working with several adolescents in a group context. It takes advantage of the group as a laboratory environment for experimenting with new ways of communicating and interacting with others. The IPT-AG manual, described in this paper, provides guidelines for working with multiple interpersonal issues and keeping the group discussion relevant to the group as a whole. These adaptations are discussed in the context of the interpersonal framework with respect to each phase of treatment. Preliminary data about the feasibility and acceptability of conducting IPT-AG are discussed.

A group adaptation of Interpersonal Psychotherapy for depressed adolescents

This paper describes the process of modifying and transporting an evidence-based treatment, Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), from a university setting to school-based health clinics. It addresses conceptual issues involved in the shift from efficacy to effectiveness research as well as operational issues specific to the transport of IPT-A into school-based health clinics. Consideration is given to the rationale for an IPT-A effectiveness study, methodological concerns, and the timing of the move from the “lab” to the community. The authors identify challenges and barriers to initiating effectiveness and transportability research and provide suggestions for overcoming these barriers. Recommendations for conducting research in school-based practice settings are provided.

Kristen Pollack Dorta

Papers

A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Adolescents

A group adaptation of Interpersonal Psychotherapy for depressed adolescents

Effectiveness research: transporting interpersonal psychotherapy for depressed adolescents (IPT-A) from the lab to school-based health clinics.

Interpersonal Psychotherapy for Depressed Adolescents, Second Edition