Depression among adolescents, which typically presents in primary care, is underdiagnosed and undertreated . An estimated 70 percent of depressed teenagers do not receive treatment [2-4].
This topic review will provide an overview of the treatment of adolescent depression. The diagnosis of depression in adolescents is discussed separately, as is the treatment of depression in adults. (See "Depression in adolescents: Epidemiology, clinical manifestations, and diagnosis" and "Initial treatment of depression in adults".)
There have been few well-designed controlled trials of treatments for adolescent depression. Current practice guidelines for treating adolescent depression are based upon existing data from studies in depressed adolescents, adult depression research, and clinical experience [5,6]. Two major multisite NIMH initiatives have been implemented to address the lack of objective information regarding the treatment of adolescent depression [7,8]:
- The Treatment for Adolescents with Depression Study (TADS) was launched in 1998. This trial was designed to evaluate the short- (12-week) and long-term (36-week) efficacy of treatment with fluoxetine (a selective serotonin reuptake inhibitor [SSRI]), cognitive behavioral therapy (CBT), fluoxetine plus CBT, and pill placebo in adolescents with major depressive disorder (MDD) . Adolescents considered to be at high risk of suicide (suicide attempt requiring medical attention within the previous six months, clear intent or active plan to commit suicide, or suicidal ideation with a family unable to guarantee safety) were excluded from the study. Both phases of the trial have been completed [10,11]; the results are summarized below. (See 'TADS' below.)
- The Treatment of Resistant Depression In Adolescents (TORDIA) study was initiated in 2001 to determine how to best treat the 40 percent of adolescents with MDD whose depressive symptoms do not respond to the first SSRI they have tried. Participants (334 patients aged 12 to 18 years) were randomly assigned to one of four groups: switching to an alternative SSRI (paroxetine, citalopram, or fluoxetine); switching to a non-SSRI antidepressant (venlafaxine); switching to an alternative SSRI and CBT; or switching to venlafaxine and CBT. Results were published in 2008 . The results of this study are presented separately. (See "Psychopharmacological treatment for adolescent depression".)
TADS and TORDIA provide evidence-based guidelines for how to best initiate treatment for adolescents with depression and how to respond if the first intervention is not effective.