Depression Health Article

Causes of clinical depression

Several factors are associated with the onset, duration, and recurrence of early onset MDD. Studies assessing relatives of depressed children and children of depressed parents have concluded that clinical depression runs in families. Investigations of twins who have been raised in separate families and other adoption studies have provided evidence that genetic factors predispose a person to develop clinical depression. Environmental factors such as exposure to negative events (e.g., deaths, divorce, medical illnesses), lack of support, family conflict, and aversive experiences in early childhood (neglect, death, abuse) may also contribute to the development of depression.

Several biological abnormalities, including changes in the secretion of the growth hormone and cortisol, have been linked to children and adolescents with depression. However there are no laboratory tests that diagnose MDD or dysthymic disorder. The most useful tools in diagnosing depression are (1) a thorough evaluation of depressive symptoms through interviews and observation of the child, and (2) interviews with parents and other key figures, such as teachers.

Treatment

Several treatment strategies, including different forms of psychotherapy and medication, have been developed for the treatment of MDD and dysthymic disorder in adults. Unfortunately, there has been relatively little research conducted with children and adolescents.

Psychotherapy for the acute treatment of MDD

Several types of psychotherapies have been used to treat MDD and dysthymic disorder in children and adolescents, including: psychodynamic psychotherapy, cognitive-behavioral therapy (CBT), family therapy, interpersonal therapy (IPT), social skills training, and group therapy. Though the manner of performing the different types of psychotherapy may vary, the overall goal of these therapies is to reduce the symptoms of depression. In addition, they generally try to improve the child's coping skills, problem-solving abilities, academic functioning, parent-child and peer relationships, and, at times, understanding of internal psychological processes. Cognitive-behavior therapy has been the most frequently studied psychotherapy in childhood and adolescent depression; it appears to be effective in the treatment of acute depression, prevention of relapses, and prevention of the onset of new depressions. However, studies of other forms of psychotherapy (IPT, family therapy, social skills training, group therapy) have shown that these forms of therapy are potentially effective as well in treating childhood depression.

It may also be important to include parents in the treatment process because: (1) children are dependent on their parents; (2) depressed youth frequently come from families with high rates of depression or high degree of conflicts; and (3) parent psychopathology and family conflict may predict a poor outcome to treatment and increase risk for depressive recurrences.

Medication interventions for the acute treatment of MDD

Most of the studies published so far have evaluated the effects of the tricyclic antidepressants, such as nortriptyline (brand name Pamelor), imipramine (Tofranil), desipramine (Norpramin), and the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) in treating clinical depression. The studies show that some children and adolescents benefit from these medications.

Medications for treating depression differ in some ways from medications that people take for other medical illnesses. Though some people with depression notice a reduction in symptoms in a few days, most of the time there is a delay of up to 4-6 weeks for the medications to have an effect. The symptoms of depression usually do not improve all at once, but instead show a gradual and, at times, uneven improvement. Once the depression has improved, there is evidence, at least in adults, that people with depression should keep taking medication for a period of time to prevent recurrence. Lastly, all antidepressants carry a small risk of triggering a manic or hypomanic (milder form of mania) episode in vulnerable patients. (For more information on medications, please refer to Antidepressants).