​Let's Talk Mental Health
Treating Adolescent Major Depressive Disorder
6/6/24
Adolescent depression has become increasingly common within the past decade, with an estimated 13-15% of adolescents suffering from major depressive disorder (Lu, 2019). We’ve previously discussed some common causes of depression in our youth, including genetic predispositions, environmental factors, and pubertal changes. In this article, I hope to provide you with some insight on how MDD is treated in adolescents and what research tells us about the efficacy of our treatments.
Cognitive Behavioral Therapy
Undeniably the gold standard in MDD psychotherapy treatment, cognitive behavioral therapy (CBT) is one of the most common treatment options for adolescents living with depression. Although a number of other psychotherapeutic treatments exist, including family therapy (FT), psychoanalytic therapy (PT), and interpersonal therapy (IPT), CBT is believed to be the most effective at treating MDD. CBT aims to help patients identify and change maladaptive thought patterns while simultaneously addressing dysfunctional behaviors. In this form of psychotherapy, there is an emphasis on discerning specific and attainable goals for the patient. In order to do so, the therapist works closely with the client using a research-backed system called SMART (Specific Measurable Attainable Relevant Time-bound). By identifying and setting goals using this specific yet simple format, the patient can gain a sense of control over their depression.
The therapist helps elucidate maladaptive thought patterns and cognitive distortions, providing the patient with an arsenal of tactics to restructure them. By allowing the patient to recognize and identify their thoughts and behaviors as potentially irrational or unhelpful in the therapeutic setting, clients are then able to apply these skills in real life. Clients are often provided with homework assignments and ongoing evaluations to keep them on track and on top of their mental health.
A series of literature reviews have been conducted to evaluate the efficacy of CBT for depressed youth, demonstrating strong support for its use. While CBT is considered a rather reliable treatment on its own, with one study suggesting approximately 48% of patients benefit significantly from it, some suggest that it be combined with some form of medication (March et al., 2004). In the following section, we will discuss the most common pharmaceutical approaches for treating adolescent depression.
Pharmaceutical Interventions
While pharmacotherapy is considered rather common in adult populations, its application to young patients has become a controversial topic. One of the first-choice medications for the treatment of juvenile depression is the selective serotonin reuptake inhibitor (SSRI) fluoxetine. By increasing the availability of serotonin in the brain, fluoxetine can help mitigate some of the negative symptoms common to MDD. Other SSRIs like sertraline, escitalopram, and citalopram have also been methodically researched and used in the clinical setting.
Studies have shown that fluoxetine, along with other SSRIs can be effective in treating MDD in children and adolescents (March et al., 2004). Unfortunately, such pharmaceutical options are accompanied by a range of negative side effects. One of the most glaring and disconcerting being an increase in suicidality. This can be extremely alarming to parents and is one of the main reasons that some avoid pharmacotherapy all together. In addition, these drugs can cause insomnia, weight gain, sexual dysfunction, and gastrointestinal issues. That said, when taken alone, fluoxetine was 62% effective in mitigating MDD symptoms. Response rates also increase with time, showing that at 36 weeks, fluoxetine therapy was 82% effective. In addition, when fluoxetine was used in conjunction with CBT, response rates hovered around 86%, providing great promise for children and adolescents with depression.
Moving Forward
Although it is clear we have managed to develop a handful of efficacious treatments for treating adolescent MDD, it is pertinent that we continue to fund and conduct research aimed at addressing treatment non-responders. Our mission cannot be considered complete until all adolescents diagnosed with MDD are able to receive effective treatment.
