Updates in treatment of depression in children and adolescents

Hazell, Philip

doi:10.1097/yco.0000000000000749

Cited by 22 publications

(18 citation statements)

References 37 publications

(43 reference statements)

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“…Underlying mechanisms may also differ from those in adults (Beesdo et al, 2009;Hazell, 2021;Hunter & McEwen, 2013;Schmaal, Hibar et al, 2017;Schmaal, Yucel et al, 2017). Notable risk factors for adolescent anxiety/depression include current life stressors, negative thought processes such as rumination, and sleep-related problems (Blake et al, 2018;Palmer et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Persistence of Anxiety/Depression Symptoms in Early Adolescence: A Prospective Study of Daily Life Stress, Rumination, and Daytime Sleepiness in a Genetically Informative Cohort

et al. 2022

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In this prospective study of mental health, we examine the influence of three interrelated traits — perceived stress, rumination, and daytime sleepiness — and their association with symptoms of anxiety and depression in early adolescence. Given the known associations between these traits, an important objective is to determine the extent to which they may independently predict anxiety/depression symptoms. Twin pairs from the Queensland Twin Adolescent Brain (QTAB) project were assessed on two occasions (N = 211 pairs aged 9−14 years at baseline and 152 pairs aged 10−16 years at follow-up). Linear regression models and quantitative genetic modeling were used to analyze the data. Prospectively, perceived stress, rumination, and daytime sleepiness accounted for 8−11% of the variation in later anxiety/depression; familial influences contributed strongly to these associations. However, only perceived stress significantly predicted change in anxiety/depression, accounting for 3% of variance at follow-up after adjusting for anxiety/depression at baseline, although it did not do so independently of rumination and daytime sleepiness. Bidirectional effects were found between all traits over time. These findings suggest an underlying architecture that is shared, to some degree, by all traits, while the literature points to hypothalamic–pituitary–adrenal (HPA) axis and/or circadian systems as potential sources of overlapping influence and possible avenues for intervention.

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Section: Discussionmentioning

confidence: 99%

Persistence of Anxiety/Depression Symptoms in Early Adolescence: A Prospective Study of Daily Life Stress, Rumination, and Daytime Sleepiness in a Genetically Informative Cohort

et al. 2022

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“…With regard to the young individuals that experienced residual symptoms of depression and sleep difficulties at the end of the study period, we suggest that psychotherapy alone might be insufficient. Recent findings in treatment research show that adolescents with severe depression and endogenous features constitute a subgroup that are more likely to respond to pharmacotherapy than patients with less severe depression [34]. There is a need for more research on how to angle evidence-based treatment for these adolescents.…”

Section: Discussionmentioning

confidence: 99%

Do Sleep Disturbances Improve Following Psychoanalytic Psychotherapy for Adolescent Depression?

Schønning

Dahl

Hummelen

et al. 2022

IJERPH

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Sleep disturbance is often a prominent symptom in adolescents diagnosed with major depressive disorder (MDD). Recent evidence indicates that short-term psychoanalytic psychotherapy (STPP) for depression may have an effect in reducing co-occurring sleep disturbance in youth. It is unknown if transference work (exploration of the patient–therapist relationship) has an additional effect in reducing sleep disturbance. Adolescents aged 16–18 years (n = 69, 84% female) who met diagnostic criteria for MDD based on the Mini International Neuropsychiatric Interview (M.I.N.I) were randomized to either STPP with transference work or without. Sleep problems were assessed at baseline, therapy session 20 (20 weeks), post-treatment (28 weeks), and one-year follow-up (80 weeks) with the Symptom Checklist-90-R. At baseline, 69% of the adolescents exhibited moderately to extreme sleep difficulties. Sleep disturbance was significantly correlated to depression depth at session 20 and at follow-up. Symptoms of insomnia significantly decreased from baseline to the end of treatment. Treatment gains were maintained until follow-up. No differences in recovery of sleep disturbance were found between the two treatment groups. The findings suggest that sleep disturbance improves following STPP for depression, with or without transference work. Future research should assess those with residual symptoms by different sleep measures.

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“…Depression and anxiety disorders affect a large number of people worldwide, which is placing an increasing burden on health services ( Hazell, 2021 ). Nowadays, approaches to treatment include antidepressant and mood-stabilizing drugs, psychotherapy, and physical activity.…”

Section: Introductionmentioning

confidence: 99%

Population pharmacokinetics model for escitalopram in Chinese psychiatric patients: effect of CYP2C19 and age

et al. 2022

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Objective: To establish a population pharmacokinetic model in Chinese psychiatric patients to characterize escitalopram pharmacokinetic profile to identify factors influencing drug exposure, and through simulation to compare the results with the established therapeutic reference range.Methods: Demographic information, dosing regimen, CYP2C19 genotype, concomitant medications, and liver and kidney function indicators were retrospectively collected for inpatients taking escitalopram with therapeutic drug monitoring from 2018 to 2021. Nonlinear mixed-effects modeling was used to model the pharmacokinetic characteristics of escitalopram. Goodness-of-fit plots, bootstrapping, and normalized prediction distribution errors were used to evaluate the model. Simulation for different dosing regimens was based on the final estimations.Results: The study comprised 106 patients and 337 measurements of serum sample. A structural model with one compartment with first-order absorption and elimination described the data adequately. The population-estimated apparent volume of distribution and apparent clearance were 815 and 16.3 L/h, respectively. Age and CYP2C19 phenotype had a significant effect on the apparent clearance (CL/F). CL/F of escitalopram decreased with increased age, and CL/F of poor metabolizer patients was significantly lower than in extensive and immediate metabolizer patients. The final model-based simulation showed that the daily dose of adolescents with poor metabolizer might be as high as 15 mg or 20 mg and referring to the therapeutic range for adults may result in overdose and a high risk of adverse effects in older patients.Conclusion: A population pharmacokinetics model of escitalopram was successfully created for the Chinese population. Depending on the age of the patients, CYP2C19 genotype and serum drug concentrations throughout treatment are required for adequate individualization of dosing regimens. When developing a regimen for older patients, especially those who are poor metabolizers, vigilance is required.

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Updates in treatment of depression in children and adolescents

Cited by 22 publications

References 37 publications

Persistence of Anxiety/Depression Symptoms in Early Adolescence: A Prospective Study of Daily Life Stress, Rumination, and Daytime Sleepiness in a Genetically Informative Cohort

Persistence of Anxiety/Depression Symptoms in Early Adolescence: A Prospective Study of Daily Life Stress, Rumination, and Daytime Sleepiness in a Genetically Informative Cohort

Do Sleep Disturbances Improve Following Psychoanalytic Psychotherapy for Adolescent Depression?

Population pharmacokinetics model for escitalopram in Chinese psychiatric patients: effect of CYP2C19 and age

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