Chapter 3 - Depression in children and adolescents: evidence-based treatment guidelines

Abstract

There has been a surge in clinical trials addressing depression in children and adolescents, with a predominant focus on cognitive-behavioral therapy (CBT), interpersonal therapy for adolescents (IPT-A), and pharmacology. Emerging research is also lending support to the utility of modular treatments (e.g., Chorpita et al., 2017). Understanding a treatment's efficacy and utility is complex as several factors, including racial/ethnic background, family function, comorbidity, severity of symptoms at baseline, and early response to medication, impact treatment outcomes. This chapter aims to highlight evidence-based treatment guidelines for children and adolescents with depression and to provide resources for those wishing to implement these practices. The chapter begins by illustrating the diagnostic criteria, prevalence, and course, for two categories of unipolar affective disorders, namely, major depressive disorder and persistent depressive disorder. It then details evidence for the efficacy of CBT and IPT-A. An overview of the efficacy and safety of various medications and other biological interventions for youth with depression are provided. The chapter also summarizes the predictors, mediators, and moderators of change to be considered in the determination of first-line treatment for depressed youth. Furthermore, it delineates potential benefits and drawbacks of modular approaches to treatment along with outlining guidelines that clinicians can consider prior to implementing this approach. Lastly, the chapter provides essential practice points and recommendations for the individualization of care while emphasizing the need to monitor treatment response, and subsequent adjustment, as key components to effective treatment.