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New Program May Help Teens at High Risk for Depression

Behavioral approach was less effective if parent was depressed during child's treatment

TUESDAY, June 2 (HealthDay News) -- Teens who face a high risk of depression because their parents struggle with the disease can be helped with a behavioral therapy program geared to help such children manage their depressive tendencies, a new study suggests.

However, the approach appears to be less successful among those children whose parents are actually in the midst of a depressive episode while the treatment is being offered.

"The bottom line is that depression in adolescents can be prevented among kids who are at risk," said study author Judy Garber, director of the developmental psychopathology research training program at Vanderbilt University in Nashville, Tenn. "But this finding is consistent with other studies that have found that children who are in treatment for depression do not do as well if their parents are currently depressed."

Garber and her colleagues report their findings in the June 3 issue of the Journal of the American Medical Association.

The authors noted that only about one-quarter of depressed youth in the United States currently receive treatment for their condition.

Early behavioral intervention, they added, has previously demonstrated some success at preventing the onset of adolescent depression in the first place -- an objective they said is important given that adolescent depression significantly raises the risk for chronic depression during adulthood.

In fact, prior research suggests that children of depressed parents face a two to three times greater risk of developing depression themselves.

With this raised risk in mind, Garber and her colleagues focused on the prevention potential of a "cognitive behavioral prevention program" -- which they stress is a treatment approach that is distinct from therapy -- among 316 high-risk adolescents between the ages of 13 and 17.

The children were deemed high-risk by virtue of having at least one parent or caretaker that had either experienced a "major depressive episode" in the three years leading up to the study or had coped with three or more such episodes and/or three or more cumulative years of depression throughout the child's life.

Although the adolescents either had a history of depression or incipient depressive symptoms, neither they nor their parents had been diagnosed with bipolar I or schizophrenia, and none were taking antidepressants. As well, none had previously undergone more than eight sessions of cognitive behavioral therapy.

At four different medical centers, about half the children were randomly assigned to the cognitive behavioral group, which was exposed to once a week 90-minute group sessions for eight weeks designed to teach problem-solving skills and techniques to cope with negative and/or unrealistic thoughts. These core sessions were followed by six months of follow-up sessions.

All the children -- including the half not assigned to the cognitive intervention group -- were simply allowed to continue (or begin) whatever traditional mental health treatment they chose, outside the study confines.

Overall, Garber and her team found that those adolescents who participated in the cognitive program experienced an 11 percent lower incidence of depression compared to those children who weren't -- about 21 percent versus about 32 percent.

However, adolescents whose parents were currently depressed while they were exposed to the prevention regimen were also found to be three times as likely to experience depression themselves, compared with children in the program whose parents were not depressed at the time.

The authors concluded that this meant that the cognitive behavioral treatment was not, in fact, more effective at preventing depression among this particular group of adolescents than typical mental health care.

Garber described the findings as "interesting and "important," in that they offer further confirmation that children of actively depressed parents are themselves at risk and should be monitored.

"The message to parents is pay attention to how their children are doing if they're depressed," Garber said. "And for public health policy makers the message is that it would be good to pay attention to prevention programs."

Dr. Lorrin Koran, professor and chairman emeritus of the department of psychiatry at Duke University, said that he viewed the study as "an important exploratory effort to identify ways of preventing depression in adolescents."

However, he added, "the results are puzzling and somewhat disappointing, in that it appears that the children most at risk did not appear to be helped by the psychological intervention. So, while a study like this is certainly worth doing, a lot more investigative work exploring prevention will be needed."

More information

For resources on adolescent depression, visit the U.S. National Institute of Mental Health.

SOURCES: Judy Garber, Ph.D., director, developmental psychopathology research training program, and professor, psychology and psychiatry, Vanderbilt University, Nashville, Tenn.; Lorrin Koran, M.D., professor and chairman emeritus, department of psychiatry, Duke University, Chapel Hill, N.C.; June 3, 2009, Journal of the American Medical Association

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