B. Birmaher et al., PRACTICE PARAMETERS FOR THE ASSESSMENT AND TREATMENT OF CHILDREN AND ADOLESCENTS WITH DEPRESSIVE-DISORDERS, Journal of the American Academy of Child and Adolescent Psychiatry, 37(10), 1998, pp. 63-83
Child and adolescent major depressive disorder and dysthymic disorder
are common, chronic, familiar, and recurrent conditions that usually p
ersist into adulthood. These disorders appear to be manifesting at an
earlier age in successive cohorts and are usually accompanied by comor
bid psychiatric disorders, increased risk for suicide, substance abuse
, and behavior problems. In addition, depressed youth frequently have
poor psychosocial, academic, and family functioning, which highlights
the importance of early identification and prompt treatment. Both psyc
hotherapy and pharmacotherapy have been found to be beneficial for the
acute treatment of youth with depressive disorders. Opinions vary reg
arding which of these treatments should be offered first and whether t
hey should be offered in combination. In general, the choice of initia
l therapy depends on clinical and psychosocial factors and therapist's
expertise. Based on the current literature and clinical experience, p
sychotherapy may be the first treatment for most depressed youth. Howe
ver, antidepressants must be considered for those patients with psycho
sis, bipolar depression, severe depressions, and those who do not resp
ond to an adequate trial of psychotherapy. All patients need continuat
ion therapy and some patients may require maintenance treatment. Furth
er research is needed on the etiology of depression; the efficacy of d
ifferent types of psychotherapy; the differential effects of psychothe
rapy, pharmacotherapy, and integrated therapies; the continuation and
maintenance treatment phases; treatment for dysthymia, treatment-resis
tant depression, and other subtypes of major depressive disorder; and
preventive strategies for high-risk children and adolescents.