Pharmacotherapy and adolescent depression – an important treatment option

Dubicka, B & Brent, D. Child and Adolescent Mental Health. 22(2) pp. 59-60

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Over the past decade, rates of depression and of suicide in adolescents have been increasing (Collishaw, Journal of Child Psychology and Psychiatry, 56, 2015, 370; Bor et al., The Australian and New Zealand Journal of Psychiatry, 48, 2014, 606). At the same time, there is some evidence that rates of diagnosis and, in the US at least, referral for depression in adolescents has been declining (Libby et al., Archives of General Psychiatry, 66, 2009, 633; John et al., Psychological Medicine, 46, 2016, 3315). These worrying statistics highlight the importance of disseminating accurate information about the risks and benefits of treatments for adolescent depression, in order to combat therapeutic nihilism.

Extant controversy about the best ways to treat adolescent depression, and in particular with regards to the use of antidepressants, may have contributed to these trends. More specifically, we believe that some recent, high profile publications have incorrectly interpreted the benefit to risk ratio for the use of antidepressants in adolescent depression as unfavourable (e.g. Cipriani et al., The Lancet, 388, 2016, 881). In this editorial, we review clinical trial and pharmaco-epidemiological data that supports the retention of the use of antidepressants in the management of depressed adolescents.

Read the editorial here

 

 

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Initial severity of depression and efficacy of cognitive–behavioural therapy

Furukawa, T. A. et al. The British Journal of Psychiatry. Published online: 19 January 2017

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Image source: Jasmine Parker – Wellcome Images // CC BY-NC-ND 4.0

Background: The influence of baseline severity has been examined for antidepressant medications but has not been studied properly for cognitive–behavioural therapy (CBT) in comparison with pill placebo.

 

Conclusions: Patients suffering from major depression can expect as much benefit from CBT across the wide range of baseline severity. This finding can help inform individualised treatment decisions by patients and their clinicians.

Read the full abstract here

Pharmacological guidelines for schizophrenia

Keating, D. et al. BMJ Open. 7:e013881

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Objectives: Clinical practice guidelines (CPGs) support the translation of research evidence into clinical practice. Key health questions in CPGs ensure that recommendations will be applicable to the clinical context in which the guideline is used. The objectives of this study were to identify CPGs for the pharmacological treatment of first-episode schizophrenia; assess the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument; and compare recommendations in relation to the key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia.

 

Conclusions: An individual’s experience of using antipsychotic medication for the initial treatment of first-episode schizophrenia may have implications for future engagement, adherence and outcome. While guidelines of good quality exist to assist in medicines optimisation, the evidence base required to answer key health questions relevant to the pharmacological treatment of first-episode schizophrenia is limited.

Read the full article here

Depression – Drugs vs CBT

Primary Care Corner with Geoffrey Modest MD. BMJ Evidence-Based Medicine Blog

B0005916 The brain and Prozac

Image source: Rowena Dugdale – Wellcome Images // CC BY-NC-ND 4.0

The Agency for Healthcare Research and Quality (AHRQ) just released their clinical review comparing nonpharmacological vs pharmacological treatments for patients with major depressive disorders

Details:

  • They reviewed 44 trials from 1990-2015 of patients with mild to severe major depressive disorder (MDD)
  • Cognitive behavioral therapy (CBT) is as effective as second-generation antidepressants (SGAs, which for this review includes SSRIs, SNRIs, bupropion, mirtazapine, nefazodone, and trazodone) for mild to severe MDD, with moderate level of evidence. The evidence does not support SGAs plus CBT as being better than SGAs alone, though this was based on low quality of evidence
  • Therapy (SGA vs CBT) was discontinued at equal rates, for either SGAs or CBT, for adverse effects or patient dissatisfaction

Read the full blog post here

Read the full review here

Anxiety disorders in children and adolescents

Hill, C. et al. Paediatrics and Child Health. Published online: September 10, 2016

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Anxiety disorders are among the most common psychiatric disorders in children and adolescents. They commonly interfere with peer relationships, schooling and family life, and persist into adulthood if left untreated.

This paper gives an overview of the identification, assessment and treatment of anxiety disorders in children and young people. Identification of anxiety disorders is often poor and many young people with anxiety disorders go untreated. We present a brief review of the evidence base for pharmacological and psychological treatment approaches to the management of anxiety disorders in youth. Both have been found to be effective in the treatment of anxiety disorders, although psychological treatments such as Cognitive Behavioural Therapy (CBT) are considered the first-line treatment due to relative benefits in terms of patient safety and parental preference. Low intensity CBT approaches such as bibliotherapy and online therapies are effective and have the potential to improve access to evidence-based interventions. CBT approaches have also been found to be effective with particular patient groups, such as those with long-term physical health conditions and autism spectrum disorders, who are at an increased risk of anxiety disorders.

Read the abstract here