Is Treatment Working? Detecting Real Change in the Treatment of Child and Adolescent Depression.

OBJECTIVE: Despite advances in evidence-based treatments for youth depression in recent decades, overall treatment effects are modest at best, with 30% to 50% of youth being nonresponders. Practice parameters consistently recommend systematic assessment and routine monitoring of depressive symptoms, or measurement-based care (MBC), to enhance youth depression treatment. However, the literature offers few guidelines on how to use assessment results to inform care decisions or to detect real and clinically meaningful change. Thus the current study produced reliable change indices (RCIs) per Jacobson and Truax for two commonly used standardized assessments of youth depression (ie, Patient Health Questionnaire-9 items, Modified for Adolescents [PHQ-9A], the Short Moods and Feelings Questionnaire [SMFQ]). METHOD: The study sample (N = 1,738) consisted of youths 6 to 18 years old seen in a child and adolescent psychiatry clinic of a regional pediatric medical center who completed at least one of the target depression measures. We examined the factor structure and internal reliability for the PHQ-9A, and calculated RCIs for patients with a depression-related diagnosis for both measures. RESULTS: Analyses confirmed a one-factor solution and adequate internal consistency (α = .86) for the PHQ-9A. All measures yielded acceptable test-retest reliabilities (r > 0.75) and RCIs that equate to clinical practice recommendations of using reliable changes scores of 7, 6, and 8 for the PHQ-9A, the SMFQ-Child Report, and the SMFQ-Parent Report, respectively. CONCLUSION: Psychometric validation of the PHQ-9A and these RCIs are timely and significant contributions to the treatment of youth depression, by facilitating effective use of MBC-a critical evidence-based strategy for improving treatment outcomes.

Cortical inhibitory and excitatory correlates of depression severity in children and adolescents.

OBJECTIVES: Neurophysiologic correlates of depression severity potentially have great utility in diagnosis and treatment planning. Transcranial magnetic stimulation (TMS) measures of cortical inhibition and excitability have shown promise as biomarkers in psychiatry, but no prior work has examined correlates of illness severity in pediatric mood disorders. This study sought to examine the relationship between depression severity and TMS measures of cortical inhibition and excitability in children and adolescents. METHODS: Twenty-four depressed and 22 healthy control youth underwent TMS testing (cortical silent period [CSP], short-interval intracortical inhibition at 2-ms and 4-ms interstimulus intervals (ISIs) [SICI-2,-4], resting motor threshold [RMT] and intracortical facilitation at 10-, 15-, and 20-ms ISIs [ICF-10,-15,-20]). Symptom severity was assessed with the Quick Inventory of Depressive Symptomatology (QIDS-A17-SR) and the Children's Depression Rating Scale-Revised (CDRS-R). RESULTS: In the overall sample, the following significant negative correlations were observed: CDRS-R and CSP (right hemisphere, ρ=-0.35, p=0.021); QIDS-A17-SR and CSP (left, ρ=-0.33, p=0.031; right, ρ=-0.42, p=0.004); and CDRS-R and SICI-4 (right, ρ=-0.30, p=0.042). Among healthy control participants, additional significant negative correlations were observed between QIDS-A17-SR and right ICF-10; QIDS-A17-SR and right ICF-15; and QIDS-A17-SR and left ICF-20. Among depressed participants, significant negative correlations were observed between QIDS-A17-SR and bilateral CSP; CDRS-R and bilateral ICF-10; CDRS-R and bilateral ICF-15; QIDS-A17-SR and left ICF-10; and QIDS-A17-SR and bilateral ICF-15. LIMITATIONS: Small sample, potential developmental/age- and sex-related effects. CONCLUSIONS: These preliminary results provide evidence for a relationship between depression severity and dysfunction in GABAergic and glutamatergic cortical processes in a pediatric population.

Factors Associated With the Response to Fluoxetine Treatment in Child and Adolescent Patients with Major Depressive Disorder; A Naturalistic Study / 대한정신약물학회지

OBJECTIVE: We evaluated the overall efficacy of fluoxetine and explored factors associated with the response to fluoxetine treatment in child and adolescent outpatients with major depression. METHODS: Child and adolescent outpatients with major depressive disorder who had been treated with fluoxetine for at least eight weeks were selected for a retrospective study. The medical records of the subjects (N=82) were reviewed to determine the details of clinical variables and the efficacy and pharmacological variables of fluoxetine. At eight weeks, Clinical Global Impression (CGI) scores were used to divide the subjects into two groups, i.e., clinical responders and non-responders, and the two groups were compared. RESULTS: Of the 82 patients, 64% (N=53) responded to fluoxetine treatment. Responders tended to be younger during the treatment period and tended to have had a shorter duration of depressive episodes prior to starting treatment, a lower family loading for depressive illness, and less difficulty in school than non-responders. Other variables did not differ significantly between responders and non-responders. CONCLUSION: Fluoxetine is effective for the treatment of depressed children and adolescents. Younger age, shorter duration of depressive episodes prior to starting treatment, lower family loading for depressive illness, and less difficulty in school were good predictors of the response to fluoxetine treatment.

Treatment Straegies for the Child & Adolescent Patient with Depressive Disorder / 대한정신약물학회지

Depression in children and adolescents have been increasingly recognized in clinical practice and have become the focus of extensive systematic studies. Recently diverse psychosocial and pharmacological approaches are actively applied to this disorder. In general, psychotherapy is the initial approach to depression in children and adolescents, with medication use reserved for more severe (suicidal or psychotic) cases or those not responding to psychotherapy alone. Given that only two types of psychotherapy (cognitive behavioral therapy and interpersonal therapy), and two SSRIs (fluoxetine and paroxetine) have adequate controlled short-term efficacy, clinician must judge all but the initial step based on individualized riskbenefit analysis. As depression in children and adolescents lead to many psychosocial complications, primary preventive approach must be planned and executed.