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Evidence-based treatment of adolescent major depression
  1. B Dubicka1,
  2. P Wilkinson2
  1. 1Honorary Lecturer, University of Manchester, Manchester, UK and Consultant, The Junction Adolescent Unit, Piccadilly, Lancaster, UK
  2. 2Clinical Lecturer, Section of Developmental Psychiatry, University of Cambridge, Cambridge, UK
  1. Dr B Dubicka, The Junction Adolescent Unit, Scotforth, Piccadilly, Lancaster LA1 4PW, UK; Bernadka.Dubicka{at}manchester.ac.uk

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Adolescent depression is a serious and debilitating disorder (see box). Up to one in 20 adolescents suffer from major depression at any point in time, and 20% of adolescents have at least one episode of clinical depression by the age of 18. Once depression is established it often becomes chronic. About a fifth of adolescents with major depression will continue to have a persistent disorder, and another third will recover but go on to have recurrent episodes.

CAUSATION

Depression runs in families and children of depressed parents have an increased risk of becoming depressed, which is likely to be due to both the direct effect of genes as well as the adverse influence of depressed parenting. Recent research has highlighted the complex interaction of genetic and environmental influences, such as adverse life events, in depression.

The six Cs of depression

  • Common

  • Chronic

  • Causation complex

  • Comorbidity

  • Complications

  • Commit suicide

COMPLICATIONS

Pure depression is rare, and it is usually accompanied by other psychiatric disorders. A recent UK study found that 89% of cases had a comorbid disorder and the average number of additional disorders was three.1 Other complications include school refusal, academic failure, impaired peer relations, drug and alcohol abuse, and family relationship problems. However, the most important complication is suicide and depression is the most important risk factor for suicidality. Findings from 20-year follow-up data of depressed children and adolescents have shown that 2.5% had committed suicide and nearly half had attempted suicide.

Any treatment plan for adolescent depression therefore needs to take account of the chronic, relapsing nature of the disorder, consider aetiological factors such as parental depression, and address any concurrent psychiatric disorder and psychosocial complications, particularly suicidality.

EVIDENCE-BASED PSYCHOLOGICAL TREATMENT

Early studies of cognitive behavioural therapy (CBT) were promising in the prevention and treatment of depression and meta-analyses found large effect sizes. However, a recent meta-analysis, which …

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