Running Head: TREATMENT FOR ADOLESCENT DEPRESSION
The Best Treatment Methods for Adolescent Depression
Alex Rodriguez
Auburn University
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TREATMENT FOR ADOLESCENT DEPRESSION
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Introduction
Depression is a very serious disorder that is seen often in today’s adolescent
population. In fact, depression is becoming increasingly present as children grow up and
affects 3-8% of the population by mid-adolescence (Gledhill & Hodes, 2011). Adolescent
depression can be damaging as it has a high risk of suicidality, recurrence, and chronicity
(Goodyer et al., 2007). Studies actually show that about 50-70% of patients will experience
recurrence within 5 years (Gledhill & Hodes, 2011). Suicide is also a major concern as it
associated with depression and is the third leading cause of death among this age group
(Lovrin, 2009). For these reasons, it is extremely important to determine effective
treatments for adolescent depression. Fortunately, there has been a recent increase in
research in this area, helping to illuminate the different treatments that have proven
successful. This paper will discuss these treatments and highlight the ones that are most
effective in treating adolescent depression (Gledhill & Hodes, 2011).
Discussion
The first step in determining treatment for a depressed adolescent is to perform a
thorough assessment. It is extremely important to identify the severity of the depression,
as well as assess for suicidal thinking. The severity of depression ranges from mild to
severe and can be determined by the number of symptoms the patient exhibits.
Information should be gathered from the patient, family, and school and interviews should
be done with patient and family separately as well as together. This makes it possible to
obtain a thorough history and is also a good way to determine what has worked and what
has not. At this time it is also important to discover both the patient and parents’ attitudes
TREATMENT FOR ADOLESCENT DEPRESSION
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on different treatment options as well as provide education on what is available (Gledhill &
Hodes, 2011).
Recent research has revealed many different treatments for adolescent depression
including interpersonal psychotherapy, family therapy, cognitive-behavioral therapy, and
pharmacotherapy. Interpersonal psychotherapy is a brief treatment that is centered on the
idea that responses to treatment and outcomes are influenced by the relationship between
the patients and those they care about. Focus for this type of treatment is mainly on grief,
interpersonal role disputes, role transitions, and interpersonal deficits. Family therapy
works to modify negative interactions and increase cohesion within the family as many
times conflict, separation, and loss within the family can lead to depression. Cognitivebehavioral therapy is similar to interpersonal psychotherapy in that both treatments may
vary in how they are administered; however, rather than focusing on the relationships
between the patient and significant others, cognitive-behavioral therapy focuses on the
relationships between emotions, behavior, and cognition. Components of cognitivebehavioral therapy include psychoeducation, self-monitoring such as diary keeping,
enhancing patients’ abilities to recognize emotion, challenging cognitive distortions, and
activity scheduling. Pharmacotherapy deals with the use of antidepressant drugs. This has
become a widely researched topic as it has been argued that these drugs can have
potentially negative side effects on adolescents (Gledhill & Hodes, 2011). Overall, each of
these treatments is useful in treating adolescent depression; however, the most widely
used treatments include cognitive-behavioral therapy and pharmacotherapy. Today most
research focuses on these two treatments used separately as well as together to combat
adolescent depression (Goodyer et al., 2007).
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As discussed before, antidepressants such as selective serotonin reuptake inhibitors
(SSRIs) have been used to treat adolescent depression. Unfortunately there have been
numerous concerns with this treatment regarding efficacy and the possibility of increasing
the risk of suicide (Goodyer et al., 2007). Currently, fluoxetine is considered the only SSRI
that should be used for adolescent depression. While there have been documented cases of
increased thoughts of suicide in adolescents using antidepressant medication, there were
no completed suicides in any of the studies on this topic. In fact, many large studies have
discovered that the risk of suicide attempt decreases after patients have been taking
medication and that lower rates of suicide are associated with communities that have
higher rates of antidepressant use. It should also be taken into consideration that the FDA
does not completely advise against the use of antidepressants, but instead suggests more
frequent follow up and monitoring of adolescent patients. Despite negative feelings
towards antidepressant therapy, it is still a proven remedy for adolescent depression;
however, before using any antidepressant, it should be determined how severe the
depression is and if the benefits outweigh the risks. The patients and families should be
thoroughly educated on use and side effects of the medication and if antidepressants are
used, patients should be carefully monitored for adverse effects (Lovrin, 2009).
Due to the controversy regarding the use of antidepressants such as SSRIs, cognitive
behavior therapy has become increasingly popular as a leading treatment for adolescent
depression (Goodyer et al., 2007). Unfortunately, when comparing the use of SSRIs, most
notably fluoxetine, with cognitive behavioral therapy, the drugs prove much more effective
in treating adolescent depression. In fact, one very distinguished study known as the
Treatment for Adolescents with Depression Study (TADS) stated that cognitive-behavior
TREATMENT FOR ADOLESCENT DEPRESSION
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therapy alone was not even truly superior to the placebo (Gledhill & Hodes, 2011). Since
cognitive-behavior therapy alone does not seem to be effective, it is thought that combining
fluoxetine with cognitive-behavior therapy might be superior to drug use alone and might
decrease possible suicidality.
Currently, results of combined therapy are yielding different results. For example,
TADS found that the combination of fluoxetine and cognitive-behavior therapy was
associated with a greater improvement than fluoxetine alone in those with moderate
depression. On the other hand, for those with severe depression, combination therapy did
not prove better than fluoxetine alone. However, in both cases the combination of
fluoxetine and cognitive-behavior therapy did reduce the rate of suicidality (Gledhill &
Hodes, 2011). Another study yielded completely different results stating that regardless of
the level of depression, treatment combining SSRIs with cognitive-behavior therapy did not
prove more effective than SSRIs alone. There was also no evidence that the combined
therapy protected against suicidality (Goodyer et al., 2007). Although the effectiveness of
combined therapy is still being assessed in regards to standard adolescent depression, it
has had very positive outcomes in the treatment of SSRI resistant depression. This finding
helps to support the idea that combined therapy could be a very beneficial treatment
option for adolescents with depression (Gledhill & Hodes, 2011).
Conclusion
With the high amount of depression seen in today’s adolescent population, it is clear
that determining effective treatments for these patients is critical. Current research
stresses the importance of assessing these patients before deciding on a certain plan of
treatment as many things must be taken into consideration in order to determine the best
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treatment for an individual patient. For example, one of the most important things to
establish is the patient’s level of depression. It is also important to be familiar with
whether or not the patient is having suicidal thoughts or tendencies. From here a
treatment plan can be developed which will most likely include the use of antidepressants
or cognitive-behavioral therapy (Gledhill & Hodes, 2011). Research has stressed these two
treatments as being most effective; however, with concerns about antidepressants
increasing suicidality and cognitive-behavioral therapy alone not proving effective, the idea
of combined therapy has emerged. While it is obvious that much more research needs to
be done regarding combined therapy, there is high hope that this may prove to be one of
the most effective treatments for adolescent depression (Goodyer et al., 2007).
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Works Cited
Gledhill, J. & Hodes, M. (2011). The treatment of adolescents with depression. CMLPsychiatry, 22 (1), 1-7. Retrieved from:
http://web.ebscohost.com.spot.lib.auburn.edu/ehost/detail?vid=5&hid=110&sid=5
87cd4e3-3082-4b41-abcab94ee9832b75%40sessionmgr112&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#
db=aph&AN=61292541
Goodyer, I., Dubicka, B., Wilkinson, P., Kelvin, R., Roberts, C., Byford, S., ... Harrington, R.
(2007). Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care
with and without cognitive behaviour therapy in adolescents with major
depression: Randomised controlled trial. BMJ 335 (7611), 1-8. doi:
10.1136/bmj.39224.494340.55
Lovrin, M. (2009). Treatment of major depression in adolescents: Weighing the evidence of
risk and benefit in light of black box warnings. Journal of Child and Adolescent
Psychiatric Nursing, 22 (2), 63-68. doi: 10.1111/j.1744-6171.2009.00174.x