Depressive Disorders In Youth Research Articles

The Use of Text Messaging as an Adjunct to Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder in Youth: Secondary Analysis.

As an established treatment for major depressive disorder (MDD), cognitive behavioral therapy (CBT) is now implemented and assessed in internet-based formats that, when combined with smartphone apps, enable secure text messaging. As an adjunct to such internet-based CBT (ICBT) approaches, text messaging has been associated with increased adherence and therapeutic alliance. This study analyzed data from the intervention arm of a randomized control trial evaluating 24-week ICBT for MDD (intervention arm) against standard-care psychiatry (waitlist control). The aim of this secondary analysis was to assess MDD symptom improvement in relation to the frequency and content of text messages sent by ICBT participants to Navigator-Coaches during randomized control trial participation. Higher text frequency in general and in 3 conceptual categories (appreciating alliance, alliance building disclosures, and agreement confirmation) was hypothesized to predict larger MDD symptom improvement. Participants were young adults (18-30 years) from the Centre for Addiction and Mental Health. The frequencies of categorized texts from 20 ICBT completers were analyzed with respect to MDD symptom improvement using linear regression models. Texts were coded by 2 independent coders and categorized using content analysis. MDD symptoms were measured using the Beck Depression Inventory-II (BDI-II). Participants sent an average of 136 text messages. Analyses indicated that BDI-II improvement was negatively associated with text messaging frequency in general (β=-0.029, 95% CI -0.11 to 0.048) and in each of the 3 categories: appreciating alliance (β=-0.096, 95% CI -0.80 to 0.61), alliance building disclosures (β=-0.098, 95% CI -0.28 to 0.084), and agreement confirmation (β=-0.076, 95% CI -0.40 to 0.25). Altogether, the effect of text messaging on BDI-II improvement was uniformly negative across statistical models. More text messaging appeared associated with less MDD symptom improvement. The hypothesized positive associations between conceptually categorized text messages and MDD symptom improvement were not supported in this study. Instead, more text messaging appeared to indicate less treatment benefit. Future studies with larger samples are needed to discern the optimal use of text messaging in ICBT approaches using adjunctive modes of communication. Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.

The clinical presentation of major depressive disorder in youth with co-occurring obsessive-compulsive disorder

BackgroundMajor depressive disorder (MDD) is common in youth and among the most frequent comorbid disorders in pediatric obsessive-compulsive disorder (OCD), but it is unclear whether the presence of OCD affects the symptom presentation of MDD in youth. MethodsA sample of youth with OCD and MDD (n = 124) and a sample of youth with MDD but no OCD (n = 673) completed the Patient Health Questionnaire for Adolescents (PHQ-A). The overall and symptom-level presentation of MDD were examined using group comparisons and network analysis. ResultsYouth with MDD and OCD, compared to those with MDD and no OCD, had more severe MDD (Cohen's d = 0.39) and more reported moderate to severe depression (75 % vs 61 %). When accounting for demographic variables and the overall severity of MDD, those with comorbid OCD reported lower levels of anhedonia and more severe difficulties with psychomotor retardation/agitation. No significant differences in the interconnections among symptoms emerged. LimitationsData were cross-sectional and self-reported, gold standard diagnostic tools were not used to assess OCD, and the sample size for the group with MDD and OCD was relatively small yielding low statistical power for network analysis. ConclusionsYouth with MDD and OCD have more severe MDD than those with MDD and no OCD and they experience more psychomotor issues and less anhedonia, which may relate to the behavioral activation characteristic of OCD.

Comorbidity Depression and Self-destructive Behavior in Adolescence: Comparative Sex Analysis of Clinical Cases

Today, there is a trend of intentional self-harm, suicide and injury among teenagers. Doctors pay attention that among the reasons for this situation are the depressed state of society, cruelty and indifference in the family, maladjustment in the educational institution, low neuropsychological stability of children and young people, inability to constructively solve personal problems, lack of sustainable interests and interesting organized leisure time, impossibility self-expression and self-realization, etc. The comorbid combination of depressive disorders (DD) and self-destructive behavior (SDB) in adolescence is one of the most important and global problems of modern clinical psychiatry. The gender specifics of such an aggravating variant of DD in boys and girls requires additional research. The objective: to analyze the sexual characteristics of DD in a comorbid combination with SDB in youth. Materials and methods. In the pilot study 48 boys and girls aged 15–18 years with DD (according to ICD-10) and manifestations of SDB were examined in outpatient clinic, namely: 11 (22.91%) boys and 37 (77.08%) girls. The patient health questionnaire (PHQ-9) was used in the study. Results. According to the results of the study, patients were diagnosed with different variants of clinical syndromes of DD. The level of severity of DD had no gender characteristics. Such syndromes as hysterical-depressive, depressive-hypochondriac, depressive-dysphoric syndrome were found only in girls. At the same time, hysterical-depressive syndrome occurred most often – in 29.2% of all cases in both groups. The results of the study indicate a tendency towards the predominance of bisexual identification among girls (21.6%) compared to 9.1% among boys. Conclusions. It has been proven that in youth DD have 100% comorbidity with SDB. The presented clinical cases demonstrated severe DD in youth, taking into account gender characteristics. The significant predominance of depressive-obsessive and anxiety-depressive syndromes in young men is an important factor in the comorbid development of SDB (suicidal activity) in these patients.

459. A Meta-Analysis of Functional Neuroimaging Studies of Major Depressive Disorder in Youth

459. A Meta-Analysis of Functional Neuroimaging Studies of Major Depressive Disorder in Youth

Major Depressive Disorder in Youth: A Meta-Analysis of Functional Magnetic Resonance Imaging Studies

IntroductionMajor depressive disorder (MDD) is a highly prevalent mental illness that frequently originates in early development and is pervasive during adolescence. Despite its high prevalence and early age of onset, our understanding of the potentially unique neural basis of MDD in this age group is still not well understood, and the existing primary literature on the topic includes many new and divergent results. This limited understanding of MDD in youth presents a critical need to further investigate its neural basis in youth and presents an opportunity to also improve clinical treatments that target its neural abnormalities.ObjectivesThe present study aims to advance our understanding of the neural basis of MDD in youth by identifying abnormal functional activation in various brain regions compared with healthy controls.MethodsWe conducted a meta-analysis of functional magnetic resonance imaging (fMRI) studies of MDD by using a well-established method, multilevel kernel density analysis (MKDA) with ensemble thresholding, to quantitatively combine all existing whole-brain fMRI studies of MDD in youth compared with healthy controls. This method involves a voxel-wise, whole-brain approach, that compares neural activation of patients with MDD to age-matched healthy controls across variations of task-based conditions, which we subcategorize into affective processing, executive functioning, positive valence, negative valence, and symptom provocation tasks.ResultsYouth with MDD exhibited statistically significant (p<0.05; FWE-corrected) hyperactivation and hypoactivation in multiple brain regions compared with age-matched healthy controls. These results include significant effects that are stable across various tasks as well as some that appear to depend on task conditions.ConclusionsThis study strengthens our understanding of the neural basis of MDD in youth and may also be used to help identify possible similarities and differences between youth and adults with depression. It may also help inform the development of new treatment interventions and tools for predicting unique treatment responses in youth with depression.Disclosure of InterestNone Declared

TMS use in Depressive disorder in Youth

IntroductionTrans-cranial magnetic stimulation (TMS) as a non-invasive method of altering brain activity (1) has widened the array of therapeutic options available for various psychiatric disorders.ObjectivesTrans-cranial Magnetic stimulation (TMS) as a non-invasive method of altering brain activity has widened the array of therapeutic options available for various psychiatric disorders. •A large number of studies have shown therapeutic benefits in a wide range of patient population with majority of studies in adults. •TMS is used increasingly for the treatment of child and adolescent depression. •Yet, the scarcity of studies and lack of published guidelines for this population is notable. •As TMS use is expanding in this population, an overview of the use of TMS in children and adolescents with depression may provide much needed and timely perspective on this neuropsychiatric intervention.MethodsWe searched all published studies using PubMed database, on TMS use in depressive disorders in children and adolescents. A total of 13 studies were found to have reported use of TMS in depression in children and adolescents.ResultsWe found various case series, open label studies as well as sham controlled blind studies indicating that TMS has been effective in treating depression in children and adolescents. No significant side effects were found in our review.ConclusionsStudies have shown that TMS is an effective treatment option for depressive disorders in children and adolescents. Initial studies look promising but implications in large pediatric population may be different and there is a need for more double blind, controlled trials with larger sample size.DisclosureNo significant relationships.

Systematic Review and Meta-Analysis of Anxiety and Depression in Youth With Epilepsy.

The aim of this systematic review and meta-analysis was to provide an estimate of the prevalence of anxiety and depressive disorders in youth with epilepsy (YWE). It also aimed to calculate the overall magnitude of observed differences in anxiety and depressive symptoms reported by YWE compared with healthy controls and investigate whether any factors moderated anxiety and depression outcomes in YWE. Following prospective registration, electronic databases were searched up until October 2018. Studies were included if they reported on the rate of anxiety or depression in samples of YWE, and/or if they used valid measures of anxious or depressive symptomatology in YWE compared with a healthy control sample. Twenty-three studies met inclusion criteria. The overall pooled prevalence of anxiety disorders in YWE was 18.9% (95% confidence interval [CI] 12.0%-28.5%), and for depression the pooled prevalence was 13.5% (95% CI 8.8%-20.2%). In samples of YWE compared with healthy controls, significantly higher anxiety (d = 0.57, 95% CI 0.32-0.83, p < .000) and depressive (d = 0.42, 95% CI 0.16-0.68, p < .000) symptomatology was reported. YWE report anxiety and depressive disorders and symptoms to a significantly higher degree than youth without epilepsy. There is also evidence that certain anxiety disorders (e.g. generalized anxiety disorder, separation anxiety disorder) are particularly elevated, perhaps reflecting the unique impact of epilepsy on youth psychopathology. Research is needed to understand the risk factors associated with anxiety and depressive disorders in epilepsy, and better understand how these symptoms change across development.

Is Digital Treatment the Holy Grail? Literature Review on Computerized and Blended Treatment for Depressive Disorders in Youth.

Computerized and blended treatments seem to be an attractive treatment for adolescents as an alternative to face-to-face treatment, but mental health professionals seem hesitant to use these treatment modalities. This review provides an overview of factors contributing to and withholding from using computerized or blended treatment in routine care. Three databases were searched with terms related to (1) adolescents, (2) depression, (3) computerized or blended, and (4) treatment. Of the 33 articles identified, 10 focused on unguided computerized treatments, six on guided, two on blended, two compared unguided, blended- and face-to-face treatment to no treatment, and eight studies on games. Further, two articles that were focused on an online monitoring tool and three on intervention characteristics or preferred modes of help-seeking. Evidence for effectiveness, adherence, drop-out, and forming therapeutic relations were suspected to be barriers, but are no reason to reject computerized or blended treatment. Improvement in mental health literacy and the possibility to tailor the intervention are facilitators. However, adolescents’ intention to seek help, acceptability of computerized treatment, symptom severity, time spent by therapist, and other facilities are identified as barriers and they need to be taken into account when using computerized or blended interventions. Nevertheless, computerized and blended are promising treatments for depressed youth.

Short- and Long-Term Antidepressant Clinical Trials for Major Depressive Disorder in Youth: Findings and Concerns.

The diagnosis of major depressive disorder (MDD) in U.S. youth is increasing as is the rate of antidepressant medication (ADM) treatment for the disorder. Fluoxetine and escitalopram are FDA approved for the short term and maintenance treatment of MDD in youth. Placebo-controlled short-term ADM trials represent the basis for Food and Drug Administration (FDA) approval. Meta-analyses in 2007 and 2016 revealed that short-term ADM treatment of youth diagnosed with MDD resulted in no meaningful benefit for children and only marginal benefit for adolescents. Placebo substitution trials of ADM short-term responders represent the basis for FDA approval of ADM maintenance treatment. These ADM placebo substitution maintenance trials for youth with MDD are characterized by high dropout rates, a rapid withdrawal that often can follow the switch to placebo, and relapse rates that are not dissimilar from those in the natural course of the disorder. Without the evidence from problematic ADM placebo substitution trials, there is no acceptable support for the inclusion of ADM in maintenance treatment for MDD in youth.

Effectiveness and Cost-Effectiveness of Blended Cognitive Behavioral Therapy in Clinically Depressed Adolescents: Protocol for a Pragmatic Quasi-Experimental Controlled Trial.

BackgroundCognitive behavioral therapy (CBT) is an effective intervention to treat depressive disorders in youth. However, 50% of adolescents still have depressive symptoms after treatment, and 57% drop out during treatment. Online CBT interventions have proven to be effective in reducing depressive symptoms and seem promising as a treatment for depressed adolescents. However, combining online programs with face-to-face sessions seems necessary to increase their effectiveness and monitor for suicide risk.ObjectiveIn this study, we examine the effectiveness and cost-effectiveness of a blended CBT treatment protocol, a mixture of online and face-to-face CBT, as a treatment for clinically depressed adolescents.MethodsA pragmatic quasi-experimental controlled trial will be conducted to study the effectiveness of a blended CBT treatment protocol, in which blended CBT is compared with face-to-face CBT (n=44) and treatment as usual (n=44); the latter two were collected in a previous randomized controlled trial. The same inclusion and exclusion criteria will be used: adolescents aged between 12 and 21 years, with a clinical diagnosis of a depressive disorder, and referred to one of the participating mental health institutions. Assessments will be conducted at the same time points: before the start of the intervention, during the intervention (after 5 and 10 weeks), postintervention, and at 6- and 12-month follow-ups.ResultsThe primary outcome is the presence of a depression diagnosis at 12-month follow-up. Several secondary outcomes will be measured, such as depressive symptoms, quality of life, and suicide risk. Costs and effects in both conditions will be compared to analyze cost-effectiveness. Further, moderating (age, gender, alcohol and drug use, parental depression, and other psychopathology) and mediating effects (negative automatic thoughts, cognitive emotion regulation, attributional style) will be analyzed. Also, treatment characteristics will be studied, such as characteristics of the therapists, treatment expectancy, and therapeutic alliance. Dropout rates and treatment characteristics will be measured to study the feasibility of blended CBT.ConclusionsThis study will examine the effectiveness and cost-effectiveness of a blended CBT program in which depressed adolescents are treated in mental health care. Results of blended CBT will be compared with face-to-face CBT and treatment as usual, and implications for implementation will be reviewed.Trial RegistrationDutch Trial Register (NTR6759); http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6759International Registered Report Identifier (IRRID)DERR1-10.2196/13434 RR1-10.2196/12654

CYP2C19-Guided Escitalopram and Sertraline Dosing in Pediatric Patients: A Pharmacokinetic Modeling Study.

Objective: Cytochrome P4502C19 (CYP2C19) is a highly polymorphic gene that encodes an enzyme that metabolizes escitalopram and sertraline, two selective serotonin reuptake inhibitors (SSRIs) that are FDA approved for pediatric use and commonly used to treat anxiety and depressive disorders in youth. Using pharmacokinetic (PK) models in adolescents, we sought to (1) model SSRI dosing across CYP2C19 phenotypes to compare SSRI exposure (area under curve, AUC) and maximum concentration (Cmax), (2) evaluate the impact of b.i.d. dosing (in rapid metabolizers [RM] and ultrarapid metabolizers [UM]) on SSRI exposure and Cmax, and (3) determine pharmacogenomically-informed dosing strategies to provide similar exposure across CYP2C19 phenotypes in adolescents. Methods: Using PK parameters in CYP2C19 phenotype groups and previously reported pediatric PK data for escitalopram and sertraline, we modeled exposure (AUC0-24) and Cmax and determined CYP2C19-guided dosing strategies. Results: Compared with normal CYP2C19 metabolizers treated with either escitalopram or sertraline, Cmax and AUC0-24 were higher in slower metabolizers and lower in patients with increased CYP2C19 activity, although the magnitude of these differences was more pronounced for escitalopram than for sertraline. For escitalopram, poor metabolizers (PMs) require 10 mg/day and UMs require 30 mg/day to achieve an exposure that is equivalent to 20 mg/day in a normal metabolizer (NM). For sertraline, to achieve AUC0-24 and Cmax similar to NMs receiving 150 mg/day, PMs require 100 mg/day, whereas a dose of 200 mg/day was required in rapid and UMs. For UMs, b.i.d. escitalopram dosing was necessary to achieve comparable trough levels and exposure to NMs. Conclusions: This simulation study raises the possibility that achieving similar escitalopram and sertraline plasma concentrations could require dose adjustments in CYP2C19 poor metabolizers and UMs, although the magnitude of these differences were more pronounced for escitalopram than for sertraline. However, prospective trials of pharmacogenomically guided dosing in the pediatric population are needed to extend the findings of these modeling studies.

Prevention of anxiety and depression in school children: Effectiveness of the transdiagnostic EMOTION program.

The objective of the study was to examine the effectiveness of a transdiagnostic program (EMOTION, Coping Kids Managing Anxiety and Depression) targeting symptoms of anxiety and depression in schoolchildren by comparing the intervention condition (EC) to a control condition (CC). A clustered randomized design was used with schools as the unit of randomization. Children (N = 1686) aged 8-12 years in 36 schools completed screening using the Multidimensional Anxiety Scale (MASC-Child) and The Mood and Feelings Questionnaire Short version (SMFQ-Child). Scoring 1 SD above a population-based mean on anxiety and/or depression, 873 children were invited to participate. Intent-to-treat analyses were performed, and mixed-effects models were used. Analyses revealed significant reductions of anxious and depressive symptoms as reported by the children, in which children in the intervention condition EC had almost twice the reduction in symptoms compared with the control condition CC. For parent report of the child's depressive symptoms, there was a significant decrease of symptoms in the intervention condition EC compared with CC. However, parents did not report a significant decrease in anxious symptoms in the intervention condition EC as compared with CC. A transdiagnostic prevention program, provided in schools, was successful in reducing youth-reported symptoms of anxiety and depression and parent-reported depression. The EMOTION program has the potential to reduce the incidence of anxious and depressive disorders in youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The effectiveness of high-frequency rhythmic transcranial magnetic stimulation in endogenous depressive disorders in youth

To search for neurophysiological predictors of the effectiveness of rhythmic transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in patients with depressive disorder of various nosology. Thirty-four young male patients with protracted treatment resistant depression were studied using psychopathological, psychometric methods and encephalography. A search for predictors of therapeutic efficacy was carried out in a wide range of neurophysiological indicators using different high-frequency rTMS protocols (10 Hz and 20 Hz).. The most significant changes were obtained using rTMS with a frequency of 20 Hz. A favorable effect of treatment was correlated with higher spectral power of the alpha- and beta 1-rhythm bands in EEG.

Attenuated LPP to Emotional Face Stimuli Associated with Parent- and Self-Reported Depression in Children and Adolescents.

Individuals diagnosed with a depressive disorder have been found to show reduced reactions to emotional information consistent with the hypothesis of an emotional context insensitivity. However, there are contradictory findings of enhanced reactivity and mood-congruent processing. Electroencephalography (EEG) recordings of the late positive potential (LPP) can display such blunted or enhanced activity. Due to these contradictory findings, there is a need to clarify the role of the LPP in the emergence and presence of depressive disorders especially in children. We used an emotional Go/NoGo task to investigate modulations of the LPP to emotional (fearful, happy, sad) and calm faces in a sample of children and adolescents (age 11;00-14;11) diagnosed with a depressive disorder according to diagnostic parent interviews (K-SADS-PL) (n = 26) compared to a group of age-matched healthy controls (n = 26). LPP positivity was attenuated in children and adolescents with a depressive disorder as well as with higher self-reported depressive symptoms, suggesting reduced reactivity to emotional and calm faces. This is the first study to find generally blunted LPP responses in a clinical sample of depressed youth across reporters. Such dysfunctional modulation of neural activity may represent a potential biomarker for depressive disorders. The results call for further prospective studies investigating the course of the LPP before and after the onset of a depressive disorder in youth.

2.55 Inflammatory and Neurotrophic Markers and the Pathogenesis of Major Depressive Disorder in Youth: A Preliminary Analysis

2.55 Inflammatory and Neurotrophic Markers and the Pathogenesis of Major Depressive Disorder in Youth: A Preliminary Analysis

Social Reward in Youth at Risk for Depression: A Preliminary Investigation of Subjective and Neural Differences.

Offspring of depressed parents are at risk for developing depression at rates higher than the general population. One potential mechanism linking parent and offspring depression involves attenuated reward function. Despite the importance of social incentives for adolescents, no previous studies have relied on active social incentive reward paradigms in youth at risk for depression. The present study examined differences in youth self- and parent-report measures of and neural response to social reward between youth of mothers with and those of mothers without a history of depression. Imaging data were collected on 10 youth with a depressed parent and 23 youth without depressed parent, which included a task examining neural response to social rewards. Youth and parents also completed self-report measures of social reward. Offspring of depressed parents had lower levels of parent-reported affiliation and reduced neural response to social reward in the ventral striatum and anterior cingulate cortex than offspring of parents without a history of depression. Higher parent-reported affiliation was associated with greater ventral striatal response to social reward. Data suggest that risk status differences in ventral striatal response to social acceptance may be accounted for by affiliation. No differences were found in youth self-reports of behavior. The results suggest that attenuated response to social reward, assessed through neurobiology and behavior, may be mechanistically linked to the etiology and pathophysiology of depression. Targeting social interest and engagement may be a new direction in preventing the onset of depressive disorders in youth.

Meta-analysis of Functional Neuroimaging of Major Depressive Disorder in Youth.

Despite its high prevalence and morbidity, the underlying neural basis of major depressive disorder (MDD) in youth is not well understood. To identify in youth diagnosed as having MDD the most reliable neural abnormalities reported in existing functional neuroimaging studies and characterize their relations with specific psychological dysfunctions. Searches were conducted in PubMed and Web of Science to identify relevant studies published from November 2006 through February 2015. The current analysis took place from August 21, 2014, to March 28, 2015. We retained articles that conducted a comparison of youth aged 4 to 24 years diagnosed as having MDD and age-matched healthy controls using task-based functional magnetic resonance imaging and a voxelwise whole-brain approach. We extracted coordinates of brain regions exhibiting differential activity in youth with MDD compared with healthy control participants. Multilevel kernel density analysis was used to examine voxelwise between-group differences throughout the whole brain. Correction for multiple comparisons was performed by computing null hypothesis distributions from 10 000 Monte Carlo simulations and calculating the cluster size necessary to obtain the familywise error rate control at P < .05. Abnormal levels of activation in youth diagnosed as having MDD compared with control participants during a variety of affective processing and executive functioning tasks. Compared with age-matched healthy control participants (n = 274), youth with MDD (n = 246) showed reliable patterns of abnormal activation, including the following task-general and task-specific effects: hyperactivation in subgenual anterior cingulate cortex (P < .05) and ventrolateral prefrontal cortex (P < .05) and hypoactivation in caudate (P < .01) across aggregated tasks; hyperactivation in thalamus (P < .03) and parahippocampal gyrus (P < .003) during affective processing tasks; hypoactivation in cuneus (P < .001), dorsal cingulate cortex (P < .05), and dorsal anterior insula (P < .05) during executive functioning tasks; hypoactivity in posterior insula (P < .005) during positive valence tasks; and hyperactivity in dorsolateral prefrontal cortex (P < .001) and superior temporal cortex (P < .003) during negative valence tasks. Altered activations in several distributed brain networks may help explain the following seemingly disparate symptoms of MDD in youth: hypervigilance toward emotional stimuli from the overactivation of central hubs in the subgenual anterior cingulate cortex and thalamus that lead to a cascade of other symptoms; ineffective emotion regulation despite increased activation of the dorsolateral prefrontal cortex and ventrolateral prefrontal cortex during affective processing, which may reverse across development or the clinical course; maladaptive rumination and poor executive control from difficulties shifting from default mode network activity to task-positive network activity during cognitively demanding tasks; and anhedonia from hypoactivation of the cuneus and posterior insula during reward processing.

Within-Person Changes in Individual Symptoms of Depression Predict Subsequent Depressive Episodes in Adolescents: a Prospective Study.

The current longitudinal study examined which individual symptoms of depression uniquely predicted a subsequent Major Depressive Episode (MDE) in adolescents, and whether these relations differed by sex. Adolescents (N = 240) were first interviewed in grade 6 (M = 11.86 years old; SD = 0.56; 54% female; 81.5% Caucasian) and then annually through grade 12 regarding their individual symptoms of depression as well as the occurrence of MDEs. Individual symptoms of depression were assessed with the Children's Depression Rating Scale-Revised (CDRS-R) and depressive episodes were assessed with the Longitudinal Interval Follow-up Evaluation (LIFE). Results showed that within-person changes in sleep problems and low self-esteem/excessive guilt positively predicted an increased likelihood of an MDE for both boys and girls. Significant sex differences also were found. Within-person changes in anhedonia predicted an increased likelihood of a subsequent MDE among boys, whereas irritability predicted a decreased likelihood of a future MDE among boys, and concentration difficulties predicted a decreased likelihood of an MDE in girls. These results identified individual depressive symptoms that predicted subsequent depressive episodes in male and female adolescents, and may be used to guide the early detection, treatment, and prevention of depressive disorders in youth.

Rational-emotive and cognitive-behavior therapy (REBT/CBT) versus pharmacotherapy versus REBT/CBT plus pharmacotherapy in the treatment of major depressive disorder in youth; A randomized clinical trial

Major depressive disorder is a highly prevalent and debilitating condition in youth, so developing efficient treatments is a priority for mental health professionals. Psychotherapy (i.e., cognitive behavioral therapy/CBT), pharmacotherapy (i.e., SSRI medication), and their combination have been shown to be effective in treating youth depression; however, the results are still mixed and there are few studies engaging multi-level analyses (i.e., subjective, cognitive, and biological). Therefore, the aims of this randomized control study (RCT) were both theoretical - integrating psychological and biological markers of depression in a multi-level outcome analysis - and practical – testing the generalizability of previous results on depressed Romanian youth population. Eighty-eight (N=88) depressed Romanian youths were randomly allocated to one of the three treatment arms: group Rational Emotive Behavior Therapy (REBT)/CBT (i.e., a form of CBT), pharmacotherapy (i.e., sertraline), and group REBT/CBT plus pharmacotherapy. The results showed that all outcomes (i.e., subjective, cognitive, and biological) significantly change from pre to post-treatment under all treatment conditions at a similar rate and there were no significant differences among conditions at post-test. In case of categorical analysis of the clinical response rate, we found a non-significant trend favoring group REBT/CBT therapy. Results of analyses concerning outcome interrelations are discussed.

Re-examining the risk for switch from unipolar to bipolar major depressive disorder in youth with ADHD: A long term prospective longitudinal controlled study

BackgroundRecent studies have identified subthreshold forms of bipolar (BP)-I disorder and deficits in emotional regulation as risk factors for bipolar disorder in youth. The primary aim of this study was to investigate whether emotional dysregulation and subthreshold forms of BP-I disorder increase the risk for BP switches in ADHD youth with non-bipolar MDD. MethodsWe used data from two large controlled longitudinal family studies of boys and girls with and without ADHD. Subjects (N=522) were followed prospectively and blindly over an average follow up period of 11.4 years. Comparisons were made between ADHD youth with unipolar major depression (MDD) who did (N=24) and did not (N=79) switch to BP-I disorder at follow-up. ResultsThe rate of conversion to BP-I disorder at follow up was higher in MDD subjects with subthreshold BP-I disorder at baseline compared to those without (57% vs. 21%; OR=9.57, 95% CI=1.62−56.56, p=0.013) and in MDD subjects with deficient emotional self-regulation (OR=3.54, 95% CI=1.08−11.60, p=0.037). LimitationsThe sample was largely Caucasian, so these results may not generalize to minority groups. The sample of youth with SED was small, which limited the statistical power for some analyses. ConclusionsSwitches from unipolar MDD to BP-I disorder in children with ADHD and MDD were predicted by baseline subthreshold BP-I disorder symptoms and baseline deficits in emotional regulation. More work is needed to assess whether these risk factors are operant outside the context of ADHD.