Major depressive disorder (MDD) in children and adolescents is a serious psychiatric disorder causing substantial morbidity and mortality. Depression affects up to 8% of children and adolescents, with rates of MDD as high as 6%. Futhermore, depression is a chronic and episodic condition across the age span, but particularly so in the pediatric population. While approximately 90% eventually recover from an index episode of depression, up to 40% of these youth relapse within 1-2 years, many of which, relapse within 6 months of recovery. Until recently, the lack of clear empirical evidence of effective acute treatments in this population has made research on continuation and maintenance treatments premature. However, several studies of SSRIs and specific psychotherapies have now demonstrated efficacy in acute treatment in this population. The next step, then, is to begin assessing continuation treatments that will amplify response to acute treatment, lengthen remission, and prevent relapse. Few studies, either pharmacotherapy or psychotherapy, have been reported in the area of continuation treatment. Thus, the development of a continuation treatment program is needed. Through review of several tested and proven cognitive behavioral therapy (CBT) manuals for acute adolescent CBT, collaboration with experts adolescent CBT, and conceptualization of components needed for relapse prevention both in children and adolescents, the investigators will develop and test a CBT model designed to prevent relapse. The proposed project has 2 stages: 1) To develop a practical and effective CBT manual to prevent relapse in children and adolescents (ages 8 to 17.11) who present with MDD and remit after 12 weeks of acute phase pharrnacotherapy; and 2) To conduct a feasibility test of the manual by randomizing 30 subjects to CBT plus continued pharmacotherapy versus pharmacotherapy alone. The pilot study will allow the investigators to test and modify the manual, as well as to generate effect sizes to design a future randomized, controlled-trial. ? ?
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| Kennard, Beth D; Stewart, Sunita M; Hughes, Jennifer L et al. (2008) Developing Cognitive Behavioral Therapy to Prevent Depressive Relapse in Youth. Cogn Behav Pract 15:387-399 |
