[PDF] Evaluating Treatments of Adolescent Major Depressive Disorder





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Introduction

Major depressive disorder (MDD) is

prolonged depression consisting of a loss of interest or pleasure along with four or more MDD diagnosis symptoms for at least 2 weeks.

MDD affects 12% of men and 25% of

women.

Cognitive behavioral therapy (CBT) and

selective serotonin reuptakeinhibitors (SSRIs) are the common treatment for MDD.

CBT challenges negative thought

patterns about the self and the world to create cognitive changes and reframe the mindset in MDD.

SSRI is very affective for moderate

to severe depressionbut some studies show limited improvement and low remission rates.

Goal:Determine if CBT or SSRI

monotherapy or combined therapy produces better outcomes in the adolescent population.

In adolescents diagnosed with major

depressive disorder [P], how does cognitive behavioral therapy [I] compared to SSRI drug therapy, or combination therapy [C], affect treatment outcomes [O]?

Search terms:

monotherapy Databases Searched: Pubmed, CINAHL, NCBI, JAMA and PubPsych.

Publication dates were limited to 1999-2019

Evidence table was organized using headings of: Conceptual Framework, Design/Method, Sample/Setting, Major Variables, Data Analysis, Findings, and Strengths and Weaknesses. Evaluating Treatments of Adolescent Major Depressive Disorder Haylee DegroodMHS PA Candidate, Melissa KumnoonsateMSN Candidate, Audrey LaFraughMHS PA Candidate, SatpreetNaidu MHS NP Candidate, Thanh Pham MHS PA Candidate, Dylan Scalzo MSN Candidate, Paulina VyhmeisterMSNCandidate

PICO Question:

Methods

Evidence

Kennard, et al(2006) found a significantly higher remission rate in the SSRI + CBT group (37%) relative to the other treatment groups (SSRI 23%; CBT 16%; placebo, 17%). Suggests combination therapy (SSRI + CBT) is superior to monotherapy, regardless of whether it is SSRI alone or CBT alone. March el. al (2007) reached the same conclusion but found that combination therapy also reduced suicidality Riggs et. al was slightly less conclusive, but still indicated combination therapy as superior as it included a reduction in substance abuse. Goodyer(2007), and Davey et. al found no difference between SSRI monotherapy and combination therapy. Dunlop et. al (2019) found no difference in sequential efficacy but confirmed combination therapy as more efficacious. Nakagawa, et. al (2017) found that adding CBT as a supplement to SSRI treatment is successful for pharmaco-resistantdepression in relieving symptoms. Emslieet al. (2015) found supplemental CBT therapy led to decreased relapse rates in pediatric populations compared to SSRIs (62% vs. 36%). In a follow up study, Kennard, et. al (2008) arrived at the same conclusion, promoting the use of CBT as a complimentary treatment

Combination therapy proved to be most

effective

There was very little difference between

SSRI and CBT monotherapy.

For individuals who are not finding

success with SSRIs, combination therapy is a step that can aid in meeting remission goals

Integrating CBT can reduce the

likelihood of relapse after SSRI therapy.

Conclusions/Further StudyEvidence

Implications

For adolescents who are reluctant to try

SSRI pharmacotherapy, CBT is an

equally viable non-pharmacological option.

Integration of combination therapy can

aid in a reduction of suicidalityand drug abuse in susceptible populations

Treatment plans must be specific to

patient needs and circumstance and will differ person to person.

Acknowledgments

Amy Nichols EdD, RN, CSN, CHSE

Michaela Davis, MSN, RN, CNS

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