Enhancing the Developmental Appropriateness of Treatment for Depression in Youth: Integrating the Family in Treatment

Abstract

Youth depression is an impairing and frequently recurrent and persistent disorder that impacts current and later development, resulting in high social and economic costs. Depression and interpersonal stress are frequently transactional, with depression powerfully negatively impacting relationships and relationship stress negatively impacting the course and outcome of depression. In this context, treatment models for youth depression that emphasize interpersonal functioning, particularly family relationships, may be particularly promising. This article has three objectives. It first reviews the current state of knowledge on the efficacy of psychosocial treatments for depression in youth, with an emphasis on the role of family involvement in treatment. Second, it discusses developmental factors that may impact the applicability and structure of family-focused treatment models for preadolescent and adolescent youth. Third, two family-based treatment models that are currently being evaluated in randomized clinical trials are described: one focusing on preadolescent depressed youth and the other on adolescents who have made a recent suicide attempt.

Mood disorders in childhood and adolescence

“…23 Family-focused interventions also have the advantage of approaching critical issues of the child's context, emerging as a promising strategy in recent years, especially in young children. 5,24 On the path to define the best treatment option for depression, the Improving the Mood with Psychoanalytic and Cognitive Therapies (IMPACT) trial is an ongoing study that is planned to recruit 540 individuals to compare effectiveness and define superiority in reducing relapse among three approaches, combined with the use of fluoxetine as needed: CBT, short term psychoanalytic therapy, and specialist clinical care. 25 Children and adolescents appear to show a response pattern different from that observed in adults with respect to antidepressants -both in terms of efficacy and adverse effects (Table 1).…”

Educating health care trainees and professionals about suicide prevention in depressed adolescents

“…As aforementioned, TADS found that the addition of CBT to medication management alleviated the increased suicide risk. There is increasing evidence for psychotherapy, particularly for family-based interventions (95). For example, attachmentbased family therapy (ABFT) was first developed to reduce depression and suicidal ideation (96).…”

Improving Care for Depression and Suicide Risk in Adolescents: Innovative Strategies for Bringing Treatments to Community Settings

“…Two major national trials in the United States (TADS, TORDIA), one large trial in the United Kingdom (ADAPT) and several smaller studies document the benefits associated with current psychosocial and pharmacologic treatments for depression in adolescents (For review, interested readers are referred to…(Tompson et al, 2012, Sakolsky and Birmaher, 2012, Birmaher et al, 2007). Cognitive-behavior therapy (CBT), Interpersonal Psychotherapy (IPT), and Attachment-Based Family Therapy for adolescent depression have documented efficacy and other promising treatment strategies are under development and expanding to younger children (Tompson et al, 2012, Kovacs et al, 2006, Kennard et al, 2008, Lenze et al, 2011).…”