Developmentally Appropriate Treatments Needed for Pediatric Depression

WESTPORT, CT (Reuters Health) Aug 27 – The treatment of depression in children and adolescents needs to be individualized, taking into account age, sex and cultural background, Dr. Nadine J. Kaslow told attendees Sunday at the American Psychological Association in San Francisco.

The treatment of child and adolescent depression appears to be biased toward pharmacological treatment and brief psychosocial interventions, Dr. Kaslow said. “Some standard practices such as longer-term traditional therapy and family therapy have not been studied as to efficacy,” she told Reuters Health.

Dr. Kaslow and colleagues at Emory University School of Medicine in Atlanta analyzed previously published studies of psychosocial and pharmacological treatments for depression in infants and pre-school children, school-age children, and adolescents. The researchers focused on treatments meeting Society for Clinical Psychology criteria for Empirically Supported Treatments.

Dr. Kaslow reports finding no studies on depressed infants and, “no good studies on medications for depression in infants and toddlers.” She said the efficacy and safety of antidepressants for children under 5 years of age remains unclear. The researchers noted that positive results were obtained using Toddler Parent Psychotherapy and massage therapy in infants and pre-schoolers at risk for depression, but found no data on studies in currently depressed children in these age groups.

In school-age children, anti-depressant medications are clinically helpful for very depressed children, but Dr. Kaslow noted “there is not a lot of empirical evidence for medications in this age group.”

“There is some indication that cognitive behavior therapy is effective [in school-age children],” but Dr. Kaslow added that little is known of its long-term outcomes. She did say that family psycho-education to improve communication and problem-solving among family members is an effective therapy in school-age children.

For adolescents, “there is more evidence that medications, particularly SSRIs, may be helpful, although the data are still mixed,” Dr. Kaslow told Reuters Health. Interpersonal therapy and short-term cognitive behavioral therapy can both be effective for the treatment of adolescent depression, she said.

“When working with depressed youth it is really important to work with the child and the family in developing a sensitive and culturally competent way to treat the depression,” Dr. Kaslow concluded. She suggested that therapies be developed with a biopsychosocial perspective following a full assessment of the child, the family, and social contacts.

Lisa Celosse and Roberta Lester-Britton specialize in treating children. Michael Sherman and David Britton specialize in treating adolescents.

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Dr. Gnap

Dr. Gnap is a family practice physician and behavioral medicine specialist in suburban Chicago.  Dr. Gnap developed the Inner Control™ Program in 1970 and has worked with thousands of people to improve and correct medical, emotional, behavioral and learning problems including performance.  He started the Inner Control program because so many patients asked, “what more can be done along with traditional treatment methods?”

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