12 - The psychotherapeutic management of major depressive and dysthymic disorders in childhood and adolescence: issues and prospects

Summary

Introduction

This chapter addresses the state of the art in the psychotherapeutic management of depressed children and adolescents. We are specifically concerned with the treatment of psychiatrically diagnosable major depressive and dysthymic disorders, but we examine the management of depressive syndromes as well. We begin by briefly discussing clinical features of depressive disorders that have implications for the design and implementation of therapeutic interventions with youths. Then we summarize peer-reviewed articles of randomized controlled trials with clinically depressed youths as well as studies with youths classified as depressed based on symptom rating scales. Finally, we discuss current issues in the psychotherapeutic management of depressed youngsters and identify topics that require further attention.

Characteristics of depressive disorders

Several clinical and contextual features of childhood and adolescent depression have particular relevance for the design and evaluation of psychotherapeutic interventions. Specifically, episodes of early-onset depressive disorders are often protracted and have high rates of recurrence; these features should inform treatment duration and length of follow-up. Depression in youngsters is also associated with concurrent (comorbid) psychiatric conditions which can complicate the course of treatment, and family dysfunction which can derail specific treatment goals for a given child.

Duration of depressive episodes

An episode of major depressive disorder (MDD) in clinically referred children lasts about 11 months, on average, with a median time to recovery of about 7–9 months (McCauley et al., 1993; Kovacs, et al., 1997b). Recovery is most likely within the first 3–12 months after the onset of the episode, but about 15% of young patients with MDD have a first episode that lasts longer than 18 months (Kovacs et al., 1984a; M. Kovacs, et al., unpublished paper).