Depression Fact Sheet for Physicians
of depression, cope with the after-effects of the depression, effectively address environmental stressors, and understand how the young person's thoughts and behaviors contribute to a relapse. If the patient is taking antidepressants, continued psychotherapy may also help to promote medication compliance.(12)
Medication
Research clearly demonstrates that antidepressant medications, especially when combined with psychotherapy, can be very effective treatments for depressive disorders in adults.(22) Using medication to treat young people, however, has caused controversy. Many doctors have been understandably reluctant to treat depressed children and adolescents with psychotropic medications because, until fairly recently, little evidence was available about the effects of antidepressants on young people.
In the last few years, however, researchers have been able to conduct randomized, placebo-controlled studies on children and adolescents. Some of the newer antidepressant medications, specifically the selective serotonin reuptake inhibitors (SSRIs), have been shown to be safe and effective for the short-term treatment of severe and persistent depression in young people, although large scale studies in clinical populations are still needed. So far, there are controlled studies showing good results for fluoxetine and paroxetine.(23,24)
It is important to note that available studies do not support the efficacy of tricyclic antidepressants (TCAs) for this age group.(25)In addition, a recent review of the role of TCAs in children and adolescents cautions that "the future therapeutic role of TCAs for children and adolescents need to be seriously weighed against lethality of overdose, the unresolved issue of possible sudden unexplained death, and the availability of safer and easier to monitor medications."(26)
Medication as a first-line course of treatment should be considered for children and adolescents with severe symptoms that would prevent effective psychotherapy, those who are unable to undergo psychotherapy, those with psychosis, and those with chronic or recurrent episodes.
To develop more science-based information on the effectiveness of both medication and psychotherapeutic treatments for adolescent depression, NIMH has started a large, controlled clinical trial at 9 sites that is being coordinated by Duke University. The sites, which may be good sources of information for family physicians, are located at New York University/New York State Psychiatric Institute, Wayne State University, University of Chicago, University of Nebraska-Creighton, University of Oregon, University of Pennsylvania, University of Texas Southwestern, Carolinas Medical Center (Charlotte, NC), and The Johns Hopkins University.
Talking With Parents
One of the most important things family physicians can do is to reassure parents that children can be effectively treated for depression. Parents are likely to be
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