Treatment For Adolescents With Depression Study Research Articles

Integrating cognitive behavioral therapy and pharmacotherapy in the treatment of adolescent depression

Recent evidence from the Treatment for Adolescents With Depression Study (TADS) suggests that combining cognitive behavioral and pharmacological treatments holds the most promise for ameliorating depression among adolescents. This article describes lessons learned during the TADS trial about how to integrate these two treatments in the care of adolescents with depression. Toward this end, both common and unique components of each perspective's approach to data gathering and treatment selection are presented. Procedures for changing “dosage” and adding adjunctive treatments to each of these interventions are also discussed. Finally, issues related to sequencing treatments and guidelines for sharing information across treatment providers are offered.

Black Box Blues: Kids and Antidepressants

March J, Silva S, Petrycki S, and the Treatment for Adolescents With Depression Study (TADS) Team. Fluoxetine, cognitive behavioral therapy, and a combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. JAMA. 2004;292:807-820.

Treatment of depression in adolescents with cognitive behavior therapy and medications: A commentary on the TADS project

This article reviews and comments on the recent Treatment for Adolescents With Depression Study (TADS) that found that cognitive behavior therapy (CBT) was less efficacious than fluoxetine alone and no more efficacious than pill placebo in the treatment of depression in adolescents. Adding CBT to fluoxetine, however, improved treatment response in terms of both the reduction of depressive symptoms and the prevention of harm-related adverse events, including suicide risk. The TADS project was impressive in many respects and generally conducted well. However, the version of CBT used in this study was a novel amalgamation of different approaches, and may have tried to do too much in an overly structured fashion, thereby possibly tying the hands of the more experienced therapists in the trial. We question, therefore, the adequacy with which CBT was implemented and the representativeness of the findings. To explore these issues, we recommend that (a) the results be broken down by therapist and site, and (b) the CBT as implemented in TADS be compared to that provided in other studies that have found greater change in adolescent depression. Finally, we also question whether it was premature to move to large multisite effectiveness trials before establishing the relative efficacy of the respective interventions.

Implementation challenges to TADS cognitive-behavioral therapy

This article discusses treatment obstacles that were frequently encountered by CBT therapists in the Treatment for Adolescents With Depression Study (TADS) trial. The most common or challenging treatment obstacles and their respective solutions were distilled from the minutes of national conference calls attended by TADS CBT supervisors and therapists. Obstacles were categorized into the following 6 themes: (1) comorbid disorders (i.e., anxiety, conduct, attention problems, and learning disorders); (2) severe depressive symptoms (i.e., anhedonia and hopelessness); (3) self-harm and suicidal ideation; (4) school refusal; (5) interpersonal factors, and; (6) treatment noncompliance. Case illustrations are provided throughout to illustrate these treatment obstacles and how they were addressed within the treatment manual.

Vulnerability to depression among adolescents: Implications for cognitive-behavioral treatment

A range of factors, including early experience, parent-child interaction patterns, biological factors, and life events, have been associated with the development of depression among adolescents. Relations between early experience, attachment insecurity, and later depression may be mediated by failures to develop adaptive social skills, the acquisition of maladaptive beliefs or schema, or neurochemical factors (such as altered hypothalamic-pituitary-adrenal response to stress, and changes in serotonergic, noradrenergic, and dopaminergic systems). Prevention and treatment models that attend to the full range of developmental, cognitive, social, and biological factors associated with risk for depression are needed. Such models must account for observed increases in rates of depression during adolescence, as well as for gender differences in rates of depression that become apparent at that time. The Treatment for Adolescents With Depression Study (TADS) treatment protocol attempts to systematically address cognitive, behavioral, and social factors associated with vulnerability for depression among youth. It is a developmentally sensitive, formulation-based treatment model.

Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial

Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial

Guideline Watch: Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd Edition

Since the publication in 2000 of APA’s Practice Guideline for the Treatment of Patients With Major Depressive Disorder (2nd Edition) (1), two important safety concerns have emerged (hepatotoxicity with nefazodone, and suicide risk and antidepressants), and two new antidepressants have been approved for use (escitalopram and duloxetine). This watch describes these developments as well as evidence that has accrued since 2000 in other areas related to the treatment of major depressive disorder.

S.17.02 The treatment for adolescents with depression study (TADS): effectiveness and safety outcomes

S.17.02 The treatment for adolescents with depression study (TADS): effectiveness and safety outcomes

The Treatment for Adolescents With Depression Study (TADS): Demographic and Clinical Characteristics

The Treatment for Adolescents With Depression Study is a multicenter, randomized clinical trial sponsored by the NIMH. This study is designed to evaluate the short- and long-term effectiveness of four treatments for adolescents with major depressive disorder: fluoxetine, cognitive-behavioral therapy, their combination, and, acutely, pill placebo. This report describes the demographic and clinical characteristics of the sample and addresses external validity. Participants are 439 adolescents, aged 12-17 years inclusively, with a primary DSM-IV diagnosis of current major depressive disorder. Baseline data are summarized and compared with those from national samples and previous trials. The sample composition is 54.4% girls, 73.8% white, 12.5% African American, and 8.9% Hispanic. The mean Child Depression Rating Scale-Revised total score is 60.1 (SD = 10.4, range 45-98) with 86.0% experiencing their first major depressive episode. The most common concurrent diagnoses are generalized anxiety disorder (15.3%), attention-deficit/hyperactivity disorder (13.7%), oppositional defiant disorder (13.2%), social phobia (10.7%), and dysthymia (10.5%). Demographic results are consistent with data from national samples and large psychopharmacology trials involving depressed adolescents. The Treatment for Adolescents With Depression Study provides a large, diverse, and representative sample of depressed adolescents that highlights the complexity of major depressive disorder in adolescents and provides a rich source for explicating the effects of moderator and mediator variables on baseline psychopathology and treatment outcome.

Opinion: Antidepressants and the Risk of Suicide in Children and Adolescents: What's the Link?

Free AccessOpinion: Antidepressants and the Risk of Suicide in Children and Adolescents: What's the Link?Adil ViraniAdil Virani1. Adjunct Professor with the College of Pharmacy and a Lecturer with the Department of Psychiatry at Dalhousie University. Also practices at the IWK Health Centre as the Clinical Pharmacy Consultant for the Pharmacy Department where he specializes in the area of child and adolescent psychiatry.Search for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/capn.9.4.1.48742PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutSuggested ReadingsGarland , E.J. (2004). Facing the evidence: Antidepressant treatment in children and adolescents. Canadian Medical Association Journal, 170(4), 489–91. Google ScholarOlfson , M., Gameroff, M.J., Marcus, S.C., & Waslick, B.D. (2003). Outpatient treatment of child and adolescent depression in the United States. Archive of General Psychiatry, 60, 1236–1242. Crossref, Google ScholarThe American College of Neuropsychopharmacology. Executive Summary. Preliminary Report of the Task Force on SSRIs and Suicidal Behavior in Youth. Available at URL: http://www.acnp.org/exec_summary.pdf. Accessed August 15,2004 Google ScholarTreatment for Adolescents With Depression Study Team. Fluoxetine, cognitive–behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004;292:807–820 Crossref, Google ScholarUS Food and Drug Administration, Centre for Drug Research and Evaluation: Antidepressant Use in Children, Adolescents, and Adults. Available at URL: http://www.fda.gov/cder/drug/antidepressants/default.htm. Accessed August 16, 2004. Google ScholarVitiello , B., Swedo, S. (2004). Antidepressant medications in children. New England Journal of Medicine, 350, 1489–1491. Crossref, Google ScholarWhittington , C.J., Kendall, T., Fonagy, P., Cottrell, D., Cotgrove, A., Boddington, E. (2004). Selective serotonin reuptake inhibitors in childhood depression: Systematic review of published versus unpublished data. Lancet, 363, 1341–1345. Crossref, Google Scholar Next article FiguresReferencesRelatedDetails Volume 9Issue 4Jun 2004 Information© The Guilford PressPDF download

Best Treatment for Depressed Adolescents: Fluoxetine Plus CBT

Preliminary results from the Treatment for Adolescents with Depression Study (TADS), presented at a recent scientific meeting, now have been published.

Treatment for Adolescents With Depression Study (TADS): Rationale, Design, and Methods

A rapidly growing empirical literature on the treatment of major depressive disorder (MDD) in youth supports the efficacy of short-term treatment with depression-specific cognitive-behavioral therapy or medication management with a selective serotonin reuptake inhibitor. These studies also identify a substantial probability of partial response and of relapse, which might be addressed by more intensive, longer-term treatments. Funded by the National Institute of Mental Health, the Treatment for Adolescents With Depression Study (TADS) is a multicenter, randomized, masked effectiveness trial designed to evaluate the short-term (12-week) and long-term (36-week) effectiveness of four treatments for adolescents with MDD: fluoxetine, cognitive-behavioral therapy, their combination, and, acutely, pill placebo. A volunteer sample of 432 subjects aged 12-17 years (inclusive) with a primary DSM-IV diagnosis of MDD who are broadly representative of patients seen in clinical practice will enter the study. The primary dependent measures rated blindly by an independent evaluator are the Children's Depression Rating Scale and, for responder analysis, a dichotomized Clinical Global Impressions-Improvement score. Consistent with an intent-to-treat analysis, all patients, regardless of treatment status, return for all scheduled assessments. This report describes the design of the trial, the rationale for the design choices made, and the methods used to carry out the trial. When completed, TADS will improve our understanding of how best to initiate treatment for adolescents with MDD.