1. Adolescent Depression Treatment Mary Mills BSN, RN

2. After being diagnosed with depression, your primary healthcare provider and/or a mental health professional will collaborate with you to decide your best treatment options. Goal: Educate you on the three main evidence-based options for treating adolescent depression

3. Important: Information in this PowerPoint is based on a research review of multiple sources. Most notably, the National Institute of Mental Health’s Treatment for Adolescents with Depression Study (TADS). TADS reviewed the short- and long-term effectiveness of an antidepressant medication and psychotherapy alone and in combination for the treatment of depression in adolescents ages 12 to 17. For more information on this study, visit: http://www.nimh.nih.gov/funding/clinical-trials-for- researchers/practical/tads/index.shtmlhttp://www.nimh.nih.gov/funding/clinical-trials-for- researchers/practical/tads/index.shtml (NIMH, 2004)

4. Evidence-based Treatment Options Psychotherapy (counseling or talk therapy) Pharmacotherapy (medication) A Combination of psychotherapy and pharmacotherapy

5. Psychotherapy Two most effective forms of therapy for adolescent depression are: Cognitive-behavioral therapy (CBT) Interpersonal Therapy (IPT) (Hamrin, Antenucci, & Magorno, 2012)

6. Cognitive-behavioral Therapy “CBT is a talk therapy that teaches a person how to better cope with the challenges of depression and life in general. Specifically, a therapist may educated you about depression, the possible causes of it and how to manage it. He or she may also help you set realistic and positive personal goals, encourage participation in pleasant activities, learn to solve social problems, discourage negative thinking, and learn how to negotiate and compromise when conflicts arise, and foster assertiveness ” (National Institute of Mental Health, n.d.).

7. Interpersonal Therapy The goals of IPT: Enhancing communication skills between you and other people Decreasing depressive symptoms by improving understanding of self and your ability to problem solve (Hamrin, Antenucci, & Magorno, 2012)

8. Pharmacotherapy Pharmacotherapy is treatment using medication The Food and Drug Administration (FDA) has approved two medications for the treatment of adolescent depression: Fluoxetine (Prozac) Escitalopram (Lexapro) They are both a particular type of antidepressant called Selective Serotonin Reuptake Inhibitors (SSRI). (Hamrin, Antenucci, & Magorno, 2012)

9. Selective Serotonin Reuptake Inhibitors (SSRI). How do they work? According to the Mayo Clinic (2013), “SSRIs ease depression by affecting naturally occurring chemical messengers (neurotransmitters), which are used to communicate between brain cells. SSRIs block the reabsorption (reuptake) of the neurotransmitter serotonin in the brain. Changing the balance of serotonin seems to help brain cells send and receive chemical messages, which in turn boosts mood.”

10. SSRI use in Adolescents If SSRIs are a treatment option for you, here are a couple of key points to remember: It may take 4 to 6 weeks for the medication to take effect Most common side effects include: Hypomania-like symptoms (increased silliness, racing thoughts, increased, energy) Headache Abdominal Discomfort (cramps, nausea) Insomnia (difficulty falling asleep) Don’t miss scheduled appointments with healthcare providers and counselors! While you are on this medication, it is important that you are closely monitored. Any increase in anger, irritability, worsening depression, or thoughts of harming yourself (suicidal ideation) should be reported to your healthcare provider or counselor immediately. (Hamrin, Antenucci, & Magorno, 2012)

11. SSRI use in Adolescents In 2003, the FDA issued an advisory warning about a possible unintended increase in suicide risk associated with the use SSRIs (Hamrin, Antenucci, & Magorno, 2012). Since its publication, multiple studies evaluating the relationship between suicidal risk and SSRIs were launched. The majority of studies concluded the benefits of the drug outweigh the risk and encouraged close monitoring and/or combination therapy to reduce suicidal risk (Hamrin, Antenucci, & Magorno, 2012 & NIMH, 2009). Concerns about SSRI use can be addressed with your counselor/mental health professional and/or primary healthcare provider.

12. A Combination of Psychotherapy and Pharmacotherapy Multiple studies confirm combination treatment as the most effective treatment option for adolescent depression (Hamrin, Antenucci, & Magorno, 2012). Throughout the TADS, a combined therapy of fluoxetine and individual CBT for major adolescent depression was found to be more effective than CBT alone, Fluoxetine alone, and a placebo. Response rates of combo therapy were: 71% at 12 weeks 85% at 18 weeks 86% at 36 weeks (NIMH, 2004 & NIMH, 2007)

13. Importance of long-term management “Long-term maintenance treatment is likely to sustain improvement and prevent recurrence among adolescents with major depression” (NIMH, 2008). Even teens who show a significant improvement in the first phase of treatment are at high risk for relapse and recurrence (Hamrin, Antenucci, & Magorno, 2012). Details of each individual’s long-term maintenance should be discussed with their counselor/ mental health professional.

14. References Mayo Clinic. (2013). Selective serotonin reuptake inhibitors (SSRIs). Retrieved from http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825 http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825 Mayo Clinic. (2013). Tests and procedure definitions: Psychotherapy. Retrieved from http://www.mayoclinic.org/tests-procedures/psychotherapy/basics/definition/prc-20013335 http://www.mayoclinic.org/tests-procedures/psychotherapy/basics/definition/prc-20013335 Hamrin, V., Antenucci, M., and Magorno, M. (2012). Evaluation and management of pediatric and adolescent. The Nurse Practitioner. 37(3). 22-30. doi:10.1097/01.NPR.0000411103.12.617.aa National Institute of Mental Health. (n.d.). Questions and answers about the NIMH treatment for adolescents with depression study (TADS). Retrieved from http://www.nimh.nih.gov/funding/clinical-trials- for-researchers/practical/tads/questions-and-answers-about-the-nimh-treatment-for-adolescents-with- depression-study-tads.shtmlhttp://www.nimh.nih.gov/funding/clinical-trials- for-researchers/practical/tads/questions-and-answers-about-the-nimh-treatment-for-adolescents-with- depression-study-tads.shtml National Institute of Mental Health. (2004). Combination treatment most effective in adolescents with depression. Retrieved from http://www.nimh.nih.gov/news/science-news/2004/combination-treatment- most-effective-in-adolescents-with-depression.shtmlhttp://www.nimh.nih.gov/news/science-news/2004/combination-treatment- most-effective-in-adolescents-with-depression.shtml National Institute of Mental Health. (2007). Depressed adolescents respond best to combination treatment: Psychotherapy combined with antidepressant medication most effective. Retrieved from http://www.nimh.nih.gov/news/science-news/2007/depressed-adolescents-respond-best-to-combination- treatment.shtml http://www.nimh.nih.gov/news/science-news/2007/depressed-adolescents-respond-best-to-combination- treatment.shtml National Institute of Mental Health. (2009). Long-term depression treatment leads to sustained recovery for most teens. Retrieved from http://www.nimh.nih.gov/news/science-news/2009/long-term-depression- treatment-leads-to-sustained-recovery-for-most-teens.shtmlhttp://www.nimh.nih.gov/news/science-news/2009/long-term-depression- treatment-leads-to-sustained-recovery-for-most-teens.shtml