The Correlation Between Adolescent Major Depression Disorder and The Types Of Treatment

By Dammy KoladeMentor: Dr. Laura Mufson

Objective

I evaluated the efficiency of four treatments for adolescents with major depressive disorder: fluxentine, cognitive-behavioral therapy, their combination, and a pill placebo.

Special Thanks

Mr. Francesco for guiding through this study and teaching me the skills to be able to complete this studyMy parents for helping and getting me the materials I needed to complete this course

Fluxentine

Definitions

SRI’s or serotonin reuptake inhibitors are medications that only block serotonin.CBT or Cognitive Behavior Therapy is the combination of two types of therapy one that identifies the problems and the other which creates solutions for the problems . Serotonin’s chemical

make up

Materials and Methods

In this study there will be adolescents (from ages12-17) with a primary DSM-IV diagnosis of current major depressive disorder.The one group patients will be administered 20 or 40mg fluxentine ( based on weight and age of the patient ) a specific SRI. (serotonin reuptake inhibitors ) .

Materials and Methods The a second group of patients will administered cognitive-behavioral therapy.Another group of patients will be administered a combination of the last two treatments (Fluxentine and CBT).And the last group of patients were administered acutely, pill placebo.

Materials and Methods

This study was a double blind placebo study . Which means that when the medicine was

given out that neither I nor the patient knew is what type of medication they received .

Materials and Methods

The experiment has three stages of the treatment of the patients

Stage 1 is a 12-week acute treatment period comparing four randomly assigned treatment groups: fluxentine (FLX), cognitive-behavioral therapy (CBT), their combination, and a pill placebo

Materials and Methods

In stage II (6 weeks), employed a treatment extension design to ask whether higher intensity treatment in partial responders to stage I treatment was helpful.Stage III, which lasts 8 weeks, focused on long-term maintenance of treatment gains.

Materials and Methods

The 120 patients were from Columbia’s Child and Adolescent Psychiatric Department.

All the patients in the study were outpatients that went to Columbia’s Presbyterian Child and Adolescent Psychiatric Department for treatment.

Materials and Methods

For responders to CBT, biweekly follow-up sessions lasted 30-50 minutes and emphasized generalization training and relapse prevention. For partial responders to CBT, weekly visits, which lasted 50 to 60 minutes (higher dose), were tailored to the patient's needs utilizing problem-specific individual or family modules

Materials and Methods

Stage II pharmacotherapy visits included biweekly or every-third-week visits, depending on response status, with responders continuing on their stage I dosing regimen.Partial responders advanced to 60 mg FLX as tolerated beginning at the week 12 office visit.

Materials and Methods

The screening process included a brief telephone interviewFollowed by a visit to the clinic in which consent and assent were obtained before an evaluation of study eligibility.

The patients that were given the combination of FLX and CBT that were making progress continued with the same treatment .The patients that were making some progress had their dosages of FLX to 60 mg and their CBT to 50 to 60 minute sessions

Materials and Methods

Results Demographics

Sample size 120

Age range (yr) 12-17 % of sample

Age 12 12.07%

Age 13 15.72%

Age 14 19.13%

Age 15 21.87%

Age 16 19.82%

Age 17 11.39%

Results

Gender

Male 45.56%

Female 54.44%

Race/ethnicityWhite 73.80%

African American 2.53%

Hispanic 8.88%

Results

Residence and School n (% )

Two-parent (52.85)

Lives with both biological/adoptive parents

(41.91)

Lives with one biological/adoptive parent

(10.93)

Results

Single-parent home (41.46 %)

Lives with biological/adoptive mother

(38.04 %)

Lives with biological/adoptive father

(3.42% )

Lives with biological/adoptive father

(3.42% )

Not living with one or both parents

(5.69%)

Currently enrolled in school

98.63%)

(Currently enrolled in gifted and talented classes

(7.29 %)

Currently enrolled in a special education program

(6.61%)

Ever repeated a grade in school

(15.53 %)

Results

Currently enrolled in school (98.63%)

(Currently enrolled in gifted and talented classes

(7.29 %)

Currently enrolled in a special education program

(6.61%)

Ever repeated a grade in school

(15.53 %)

Results

Diagnosis n (% ) n (% )

DSM-IV Diagnosis past episode After stage 3

Attention-deficit/hyperactivity (13.67) (10.96)

Oppositional defiant disorder (13.21) (4.33)

Social phobia (10.71) (3.42)

Special phobia (5.24) (2.28)

Generalized anxiety disorder (15.26) (3.20)

Result

DSM-IV Diagnosis

n (% ) n (% )

Panic disorder (0.23) (0.46)Separation

anxiety disorder(2.05) (2.28)

Enuresis (1.59) (7.29)

Substance abuse

(1.14) (1.37)

Transient tic disorder

(0.68) (0.68)

Alcohol abuse (0.68) (1.14)

DSM-IV Diagnosis n (% )current diagnosis

n (% )past episode

Bulimia (0.46) (0.46)

Conduct disorder (0.23) (0.46)

Agoraphobia (0.00) (0.23)

Substance dependence ( 0.00) (0.68)

Acute stress disorder (0.23) (0.68)

Encopresis (0.23) (0.91)

ResultsDSM-IV Diagnosis n (% )

current diagnosisn (% )

past episode

Anorexia nervosa

(0.23) (0.64)

Adjustment disorder with disturbance of conduct

(0.00)

(0.23)

Alcohol dependence (0.00) (0.23)

Adjustment disorder with mixed mood and conduct

( 0.00) (0.23)

Results Summary categories

n (% )past episode

n (% )current diagnosis

Anxiety disorders

(27.40) (10.32)

Disruptive behavior disorders

(23.46 ) (13.70)

OCD/tic disorders

(2.73) (1.14)

Substance use disorders)

(1.59) (2.51)

Results

The Table presents the percentage of adolescents who met DSM-IV criteria for other current or past psychiatric disorders. In all subjects with a coexisting psychiatric illness, MDD was determined to be the primary diagnosis and the other disorder was considered secondary to depression

Results

0

10

20

30

40

50

60

70

80

90

FLX CBT COMB Pill

current

past

DSM-IV scores before and after the study

05

101520253035404550

1st Qtr 2nd Qtr

East

West

North

Results

Summary Scores Mean +/- SD Median RangeCDRS-R Total score (depression severity) 60.10 +/- 10.39 59.00 45.00-98.00T score (depression severity) 75.48 +/- 6.43 76.00 66.00-85.00CGI CGI-S (depression severity) 4.77 +/- 0.83 5.00 3.00-7.00 CGAS (general functioning) 49.64 +/- 7.47 50.00 32.00-80.00

Results

CDRS = Children's Depression Rating Scale; CGAS = Children's Global Assessment ScaleCGI = Clinical Global ImpressionsRADS = Reynolds Adolescent Depression Scale

RADS Mean +/- SD Median Range

Total score (depression severity)

79.24 +/- 14.35 80.50 32.00- 116.00

Percentile rank (depression severity)

82.96 +/- 20.50 91.50 1.00-99.00

Results

On the CDRS a score of (45) represents mild depression where as a score of 98 represents severe depressionOn the RADS Most of the subjects fell in the moderately (40.6%) and markedly (37.8%) mentally ill categories, whereas (19.6%) adolescents were rated to be in the severely or most extremely mentally ill categories

Conclusion

After analyzing the data the treatment that was most efficient was the combination of both fluxentine and Cognitive Behavioral Therapy .When the study was finish it showed that females are two times as likely to have more severe cases of depression that males

Review of Literature

American Psychiatric Association (1994), Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). Washington, DC: American Psychiatric Association Angold A, Messer SC, Stangl D, Farmer EMZ, Costello EJ, Burns BJ (1998), Perceived parental burden and service use for child and adolescent psychiatric disorders. Am J Public Health 88:75-80 Arias E, MacDorman MF, Strobino DM, Guyer B (2003), Annual summary of vital statistics-2002. Pediatrics 112:1215-1230

Review of Literature

Ascher BH, Farmer EMZ, Burns BJ, Angold A (1996), The Child and Adolescent Services Assessment (CASA): description and psychometrics. J Emot Behav Disord 4:12-20 Beck AT, Steer RA (1993), Manual for the Beck Hopelessness Scale (BHS). San Antonio, TX: The Psychological Corporation Beck AT, Steer RA, Brown GK (1996), Manual for the Beck Depression Inventory-II. San Antonio, TX: The Psychological Corporation Brent DA, Moritz G, Bridge J, Perper J, Canobbio R (1996), The impact of adolescent suicide on siblings and parents: a longitudinal follow-up. Suicide Life Threat Behav 26:253-259 Brent DA, Holder D, Kolko D et al. (1997), A clinical psychotherapy trial for adolescent depression comparing cognitive, family and supportive therapy. Arch Gen Psychiatry 54:877-885