Pediatric unipolar depression: Psychotherapy
- Liza Bonin, PhD
Liza Bonin, PhD
- Associate Professor of Pediatrics and Psychiatry
- Baylor College of Medicine
- C Scott Moreland, DO
C Scott Moreland, DO
- Clinical Assistant Professor
- Baylor College of Medicine
Psychosocial interventions teach patients and their families to understand themselves and the nature of depression, as well as to effectively manage relationships and life stressors associated with depression . Psychosocial interventions also help the patient to cope with depressive symptoms, improve social and self-management skills, and increase self-confidence.
Psychosocial treatments include, but are not limited to, cognitive-behavioral therapy (CBT), interpersonal therapy for adolescents (IPT-A), family therapy, dynamic therapy, group therapy, and supportive therapy. Among these, only CBT and IPT-A have been shown to be efficacious in controlled research within a delineated population .
The psychosocial interventions for the treatment of adolescent depression will be discussed below. An overview of treatment for adolescent depression and pharmacologic treatments for adolescent depression are discussed separately. (See "Overview of prevention and treatment for pediatric depression" and "Pediatric unipolar depression and pharmacotherapy: Choosing a medication".)
Independent of the psychosocial treatment strategy employed, the following considerations are important for effective intervention:
●Once adolescent depression has been identified, psychosocial treatment begins with a systematic assessment of the different domains that will be targets for intervention (ie, cognitive, behavioral, emotional, and interpersonal) using multiple methods and informants.
- Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. AACAP. J Am Acad Child Adolesc Psychiatry 1998; 37:63S.
- Chambless DL, Hollon SD. Defining empirically supported therapies. J Consult Clin Psychol 1998; 66:7.
- Brent DA, Kolko DJ, Birmaher B, et al. Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. J Am Acad Child Adolesc Psychiatry 1998; 37:906.
- Shirk, SR, Russell, RL. Change processes in child psychotherapy: Revitalizing treatment and research. Guilford, New York 1996.
- Reyes-Portillo JA, Mufson L, Greenhill LL, et al. Web-based interventions for youth internalizing problems: a systematic review. J Am Acad Child Adolesc Psychiatry 2014; 53:1254.
- Birmaher B, Brent D, AACAP Work Group on Quality Issues, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 2007; 46:1503.
- Reinecke MA, Ryan NE, DuBois DL. Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry 1998; 37:26.
- Kaslow NJ, Thompson MP. Applying the criteria for empirically supported treatments to studies of psychosocial interventions for child and adolescent depression. J Clin Child Psychol 1998; 27:146.
- Kazdin AE, Weisz JR. Identifying and developing empirically supported child and adolescent treatments. J Consult Clin Psychol 1998; 66:19.
- 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.
- Wood A, Harrington R, Moore A. Controlled trial of a brief cognitive-behavioural intervention in adolescent patients with depressive disorders. J Child Psychol Psychiatry 1996; 37:737.
- March J, Silva S, Petrycki S, et al. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA 2004; 292:807.
- Kroll L, Harrington R, Jayson D, et al. Pilot study of continuation cognitive-behavioral therapy for major depression in adolescent psychiatric patients. J Am Acad Child Adolesc Psychiatry 1996; 35:1156.
- Clarke GN, Rohde P, Lewinsohn PM, et al. Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions. J Am Acad Child Adolesc Psychiatry 1999; 38:272.
- Harrington R, Whittaker J, Shoebridge P, Campbell F. Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. BMJ 1998; 316:1559.
- Weisz JR, McCarty CA, Valeri SM. Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychol Bull 2006; 132:132.
- Compton SN, March JS, Brent D, et al. Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review. J Am Acad Child Adolesc Psychiatry 2004; 43:930.
- March JS, Silva S, Petrycki S, et al. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry 2007; 64:1132.
- Blackburn IM, Moore RG. Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression. Br J Psychiatry 1997; 171:328.
- Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA 2008; 299:901.
- Lewinsohn PM, Clarke GN, Hops H, Andrews J. Cognitive behavioral treatment for depressed adolescents. Behav Ther 1990; 21:385.
- Rohde P, Clarke GN, Lewinsohn PM, et al. Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression. J Am Acad Child Adolesc Psychiatry 2001; 40:795.
- Fleming T, Dixon R, Frampton C, Merry S. A pragmatic randomized controlled trial of computerized CBT (SPARX) for symptoms of depression among adolescents excluded from mainstream education. Behav Cogn Psychother 2012; 40:529.
- Stasiak K, Hatcher S, Frampton C, Merry SN. A pilot double blind randomized placebo controlled trial of a prototype computer-based cognitive behavioural therapy program for adolescents with symptoms of depression. Behav Cogn Psychother 2014; 42:385.
- Smith P, Scott R, Eshkevari E, et al. Computerised CBT for depressed adolescents: Randomised controlled trial. Behav Res Ther 2015; 73:104.
- Merry SN, Stasiak K, Shepherd M, et al. The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial. BMJ 2012; 344:e2598.
- Clarke G, McGlinchey EL, Hein K, et al. Cognitive-behavioral treatment of insomnia and depression in adolescents: A pilot randomized trial. Behav Res Ther 2015; 69:111.
- Garber J, Clarke GN, Weersing VR, et al. Prevention of depression in at-risk adolescents: a randomized controlled trial. JAMA 2009; 301:2215.
- Beardslee WR, Brent DA, Weersing VR, et al. Prevention of depression in at-risk adolescents: longer-term effects. JAMA Psychiatry 2013; 70:1161.
- Brent DA, Brunwasser SM, Hollon SD, et al. Effect of a Cognitive-Behavioral Prevention Program on Depression 6 Years After Implementation Among At-Risk Adolescents: A Randomized Clinical Trial. JAMA Psychiatry 2015; 72:1110.
- Lewinsohn PM, Clarke GN. Psychosocial treatments for adolescent depression. Clin Psychol Rev 1999; 19:329.
- Kennard BD, Emslie GJ, Mayes TL, et al. Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder. J Am Acad Child Adolesc Psychiatry 2008; 47:1395.
- Kennard BD, Emslie GJ, Mayes TL, et al. Sequential treatment with fluoxetine and relapse--prevention CBT to improve outcomes in pediatric depression. Am J Psychiatry 2014; 171:1083.
- Mufson, L, Moreau, D, Weissman, MM, Klerman, G. Interpersonal psychotherapy for depressed adolescents. Guilford, New York 1993.
- Klerman, GL, Weissman, MW, Rounsaville, BJ, Cheveron, ES. Interpersonal psychotherapy for depression (The Master Work Series), Jason Aronson, New York 1984.
- Moreau D, Mufson L, Weissman MM, Klerman GL. Interpersonal psychotherapy for adolescent depression: description of modification and preliminary application. J Am Acad Child Adolesc Psychiatry 1991; 30:642.
- Mufson L, Moreau D, Weissman MM, et al. Modification of interpersonal psychotherapy with depressed adolescents (IPT-A): phase I and II studies. J Am Acad Child Adolesc Psychiatry 1994; 33:695.
- Mufson L, Weissman MM, Moreau D, Garfinkel R. Efficacy of interpersonal psychotherapy for depressed adolescents. Arch Gen Psychiatry 1999; 56:573.
- Mufson L, Dorta KP, Wickramaratne P, et al. A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Arch Gen Psychiatry 2004; 61:577.
- Rosselló J, Bernal G. The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. J Consult Clin Psychol 1999; 67:734.
- Mufson, L, Pollack Dorta, K. Interpersonal therapy for depressed adolescents. In: Evidence-based Psychotherapies for Children and Adolescents. Guilford, New York 2003.
- Dietz LJ, Weinberg RJ, Brent DA, and Mufson L. Family-based interpersonal psychotherapy (FB-IPT) for depressed preadolescents: Examining efficacy and potential treatment mechanisms. J Am Acad Child Adolesc Psychiatry 2015.
- Hammen C, Rudolph K, Weisz J, et al. The context of depression in clinic-referred youth: neglected areas in treatment. J Am Acad Child Adolesc Psychiatry 1999; 38:64.
- GENERAL PRINCIPLES
- Choosing a therapist
- Treatment plan
- COGNITIVE-BEHAVIORAL THERAPY (CBT)
- Studies of CBT
- - Acute phase
- - Maintenance phase and prevention
- - Summary
- Adverse effects
- Typical course of CBT
- INTERPERSONAL PSYCHOTHERAPY FOR ADOLESCENTS (IPT-A)
- Studies of IPT-A
- Typical course of IPT-A
- FAMILY-BASED INTERPERSONAL PSYCHOTHERAPY
- ADJUNCTIVE PSYCHOTHERAPIES
- INFORMATION FOR PATIENTS