Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents

Cox, Georgina; Callahan, Patch; Churchill, Rachel; Hunot, Vivien; Merry, Sally; Parker, Alexandra G.; Hetrick, Sarah

doi:10.1002/14651858.cd008324.pub3

Cited by 132 publications

(95 citation statements)

References 148 publications

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“…Regarding the effectiveness of pharmacological, psychological, and combined treatment, there was limited evidence to conclude about the superiority of any treatment over another. 29 In respect to the effectiveness and safety of pharmacological treatment options for child and adolescent depression, the systematic review of the literature highlighted the high heterogeneity among available studies, but suggested that fluoxetine should be the treatment of choice if pharmacological treatment is considered. 30 The same authors also reviewed the available evidence on interventions for preventing relapse and recurrence of depression in children and adolescents,…”

Section: Treatmentmentioning

confidence: 99%

Mood disorders in childhood and adolescence

Rocha

Zeni

Caetano

et al. 2013

Rev. Bras. Psiquiatr.

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The identification and treatment of mood disorders in children and adolescents has grown over the last decades. Major depression is one of the most common and debilitating disorders worldwide, imposing a massive burden to the youth population. Bipolar disorder is being increasingly recognized as having its roots early in life, and its presentation during childhood and adolescence has been submitted to extensive research. This review aims to highlight clinical aspects of the current knowledge on mood disorders in the pediatric population, presenting updated information on epidemiology, diagnostic procedures, and management strategies. Limitations of available evidence and future directions of research in the field are also discussed.

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Section: Treatmentmentioning

confidence: 99%

Mood disorders in childhood and adolescence

Rocha

Zeni

Caetano

et al. 2013

Rev. Bras. Psiquiatr.

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“…Whereas in adolescence there are a significant number of RCTs of both pharmacological and psychological interventions [7,8,9], literature in younger children (12 and under) is starkly lacking. It is possible that antidepressant medication may have a different level of efficacy in younger children and medication is also less likely to be acceptable to families of younger children.…”

Section: Introductionmentioning

confidence: 99%

Psychological treatments for depression in pre-adolescent children (12 years and younger): systematic review and meta-analysis of randomised controlled trials

Forti-Buratti

Saikia

Wilkinson

et al. 2016

Eur Child Adolesc Psychiatry

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(250 words)Objective: To evaluate the efficacy of psychological treatments for depression in pre-adolescent children, a disorder affecting 1-2% of children in this age-range. Design:Systematic review of studies of psychological interventions to treat depressive disorder in preadolescent children (aged up to 12 years old). The primary outcome was level of depressive symptoms.Data Sources: Studies were found using Medline, PsycINFO, EMBASE and Web of Knowledge databases and selected on several criteria.Eligibility criteria for selecting studies: Only randomised controlled trials were included. Where individual studies covered a broader age range (usually including adolescents up to age 18 years), authors of those studies were contacted and requested to provide individual patient level data for those aged 12 years and younger.Results: 2822 abstracts were reviewed, and from these 124 full text articles were reviewed, yielding 7 studies for which we were able to access appropriate data for this review. 5 of these studies evaluated cognitive behaviour therapy (CBT). Combined results from these studies suggest that there is a lack of evidence that CBT is better than no treatment (Standard Mean Difference -0.342 (95% Confidence Interval -0.961, 0.278), although the number of participants included in the trials was relatively small. The evidence for efficacy of family therapy and psychodynamic therapy is even more limited. Conclusion:The very limited number of participants in randomised controlled trials means that there is inconclusive evidence for the psychological treatment of depression in children aged 12 years and under. Given the prevalence and significant impact of this disorder, there is an urgent need to establish the effectiveness or otherwise of psychological intervention.Final accepted version -Published version is in European of Child and Adolescent Psychiatry, 2016. Please cite as: Forti-Burratti A, Sakhia R, Wilkinson E, Ramchandani PG. Psychological treatments for depression in preadolescent children (12 years and younger): systematic review and meta-analysis of randomised controlled trials. European of Child and Adolescent Psychiatry.

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“…Another reason to reconsider the DSM diagnosis of adolescent MDD is that, in general, psychiatric diagnoses are only meaningful when linked to evidence-based treatment and a Cochrane meta-analysis that included more than 1,300 participants concluded that: “there is very limited evidence upon which to base conclusions about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these interventions in children and adolescents” (13). Importantly, this meta-analysis included individual studies that are often used to advocate for cognitive behavioural therapy (CBT) and antidepressant medication for treating adolescent depression, such as the Treatment for Adolescents with Depression Study (14), funded by the National Institute of Mental Health.…”

Section: Introductionmentioning

confidence: 99%

“…CBT is currently the most common psychological treatment for adolescent depression, but even though it is considered evidence-based in adult MDD, it has not shown reliable longstanding effects in adolescents (13). It has been speculated that CBT, which was originally developed for adults, may not be as effective for adolescents with MDD due to differences in cognitive control (15) and reward sensitivity (16).…”

Section: Introductionmentioning

confidence: 99%

The neuroscience and context of adolescent depression

Blom

Connolly

et al. 2016

Acta Paediatrica

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Adolescent depression is a growing public health concern with an increased risk of negative health outcomes, including suicide. The use of antidepressants and psychotherapy has not halted its increasing prevalence and there is a critical need for effective prevention and treatment. We reviewed the neuroscience of adolescent depression, with a focus on the neurocircuitry of sustained threat and summarised contextual factors that have an impact on brain development and the pathophysiology of depression. We also reviewed novel treatment models. Conclusion Attention to the relevant neurocircuitry and contextual factors implicated in adolescent depression is necessary to advance prevention and treatment development.

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Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents

Abstract: Analysis 4.3. Comparison 4 Combination therapy versus psychological therapy plus placebo, Outcome 3 Remission by cutoff (post-intervention).

Cited by 132 publications

References 148 publications

Mood disorders in childhood and adolescence

Mood disorders in childhood and adolescence

Psychological treatments for depression in pre-adolescent children (12 years and younger): systematic review and meta-analysis of randomised controlled trials

The neuroscience and context of adolescent depression

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