Childhood Depression Is Understudied and Under-treated

What's increasingly well known is that Depression often begins early in childhood. What's hardly known is what to do about it.

"The chronicity, morbidity, and mortality associated with Depression in youths make the current state of knowledge a cause for great concern," wrote Neal D. Ryan, M.D., in the Sept. 10 issue of The Lancet. "The clinician faced with a depressed child or adolescent cannot in good faith merely suggest waiting for the healing effects of time."

But evidence for the efficacy of various drugs and psychotherapeutic interventions to counter Depression in kids and teenagers is scant at best, said Dr. Ryan, a psychiatric researcher at the Western Psychiatric Institute and Clinic at the University of Pittsburgh.

In the U.S., an estimated 1% to 2% of children from the ages of six to 12 years, and about twice as many adolescents (13-18 years), suffer from a major depressive disorder. It's thought that as many as 25% of youngsters will have at least one episode of major Depression before reaching adulthood, Dr. Ryan wrote.

Despite these figures, there are many fewer clinical studies of treatment for childhood depression compared with adult depression, due in part to fewer patients, less funding, and fewer investigators specializing in this area.

When it comes to antidepressant agents used in adults, "because the market for these agents in youth is small and because typically the compounds are tested in youth late (so the compounds have little patent life remaining), there is little incentive to keep trying if early studies are either negative or borderline," he wrote.

• Consider options for treatment of Depression in children and adolescents that appear to be effective, on the basis of clinical studies. These options include cognitive behavioral therapy and interpersonal therapy, Prozac (fluoxetine), and, perhaps, other selective serotonin reuptake inhibitors, although evidence for the latter is limited.
• Inform parents or guardians of children who are taking antidepressant medications to look for signs of suicidal thoughts and/or behaviors.

"Therefore, assuming a particular compound works equally well in youth as in adult Depression, the chances of obtaining an FDA indication for Depression in youth are very much less since more than half of adult (and child/adolescent) antidepressant studies done in recent years have not produced a significant effect."

So what does seem to work in this population?

Cognitive behavioral therapy was shown in one study to be superior to family therapy and supportive psychotherapy at alleviating Depression. But a second study, the Treatment for Adolescents with Depression Study (TADS), found that a combination of and cognitive behavioral therapy was the most effective means of treating teens with depression. In this study, Prozac alone was almost as good as the combination therapy, with cognitive behavioral therapy contributing an additional 10% benefit.