title: Prevention and treatment of child and adolescent depression: challenges and opportunities.
abstract: OBJECTIVE
  To examine the current theoretical rationale and empirical evidence for preventing and treating major depressive disorder in childhood and adolescence.
  
  
  METHODS
  Selective review of recent controlled investigations on the efficacy and safety of preventive and treatment interventions.
  
  
  RESULTS
  Even more than in adults, pediatric clinical trials in depression are dominated by symptomatic improvement with non-specific clinical contact (on average, 50% 'placebo response'). The additional benefit of specific psychotherapeutic or pharmacological treatment is on average modest. Antidepressant medication is effective in speeding up improvement, but more than a third of patients do not reach full remission even after prolonged treatment. The advantage of routinely combining medication with cognitive-behavioral therapy (CBT) is unclear. Depressed suicidal adolescents can benefit from CBT and medications. CBT can protect high-risk youths from developing a depressive episode.
  
  
  CONCLUSIONS
  Effective interventions to prevent and treat depression in youth exist, but their therapeutic benefit appears to be, on average, small, possibly due to the clinical heterogeneity subsumed under the current diagnostic construct of depressive disorder. More specifically, targeted interventions tailored to individual clinical and biological characteristics may result in greater effectiveness and overall efficiency.
authors.affiliation: National Institute of Mental Health, Bethesda, MD, USA. bvitiell@mail.nih.gov
authors.forename: B
authors.initials: B
authors.lastname: Vitiello
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents