Workshop 12

 

Treatment of Adolescents with Depression

Mark Reinecke, Northwestern University, USA

 

 Mark Reinecke

Major Depressive Disorder (MDD) among adolescents is a common and increasingly significant public health concern, with a point prevalence is 1 in 20. It is associated with significant morbidity and family burden, including an increased risk of suicide and substance abuse. It also is associated with an increased risk of recurrent depression during adulthood. The Treatment for Adolescents with Depression Study (TADS) is a randomized, masked, PBO-controlled trial evaluating the effectiveness of cognitive-behavior therapy (CBT), fluoxetine (FLX), their combination (COMB), and a matched placebo pill (PBO). Acute treatment (12 weeks) outcomes revealed that the combination of FLX and CBT produced the fastest and greatest improvement in symptoms of major depression, as well as the greatest improvement in suicidal ideation. There was a slightly elevated risk of suicidality among youth receiving antidepressants, which was ameliorated by receiving CBT. Long term (36 weeks) outcomes indicated that CBT was as effective as FLX and COMB for treating MDD, and that suicidal behavior was less common in patients receiving CBT than those treated with fluoxetine. In this workshop we will briefly review cognitive and social factors associated with risk of depression, and how these are incorporated into an integrated “socio-cognitive” model of depression. This will be followed by a discussion of specific assessment and empirically-supported “modular” treatment strategies. We will conclude with a review of findings from the TADS project and recent meta-analyses of CBT with youth, and will discuss how these findings can guide clinical practice.

 
Key Objectives: Participants will acquire the following skills:
1) Objective assessment of MDD among adolescents
2) How to apply CBT techniques in a developmentally- sensitive manner
3) Selection of empirically-supported treatment modules to meet adolescents’ individual needs 4) How to effectively integrate CBT with pharmacotherapy in working with youth
5) Become familiar with the primary findings of the TADS project.

Training Modalities: In this workshop the components of assessment and treatment will be taught through instruction, modeling and role plays.

Mark A. Reinecke is Professor of Psychiatry and Behavioral Sciences and Chief of the Division of Psychology at Northwestern University. He is a Distinguished Fellow and former president of the Academy of Cognitive Therapy, and is board-certified in clinical child and adolescent psychology. Dr. Reinecke’s clinical and research interests center treatment of childhood depression and suicide, social and cognitive vulnerability for depression, and moderators and mediators of treatment response. He is a principal investigator on the NIMH Treatment of Adolescents with Depression Study (TADS), a 13-site, RCT comparing CBT and fluoxetine, alone and in combination, for adolescents with major depression.
 
References: 1) Curry, J. and Reinecke, M. (2003). Modular therapy for adolescents with major depression. In: Reinecke, M., Dattilio, F. and Freeman, A. (Eds.). Cognitive therapy with children and adolescents:  A casebook for clinical practice, 2nd Ed..  New York: Guilford Press.
2) Spence, S. and Reinecke, M. (2003). Cognitive approaches to understanding, preventing, and treating child and adolescent depression. In Reinecke, M. and Clark, D. (Eds.).  Cognitive therapy across the lifespan: Evidence and practice. Cambridge, UK: Cambridge University Press.
3) Reinecke, M. and Simons, A. (2005). Vulnerability to depression among adolescents: Implications for cognitive-behavioral treatment. Cognitive and Behavioral Practice, 12, 166-176.
4) Rogers, G., Reinecke, M., and Curry, J. (2005). Case formulation in TADS CBT.  Cognitive and Behavioral Practice, 12, 198-208.
5)  Treatment for Adolescents with Depression Study (TADS) Team. (in press). The Treatment for Adolescents with Depression Study (TADS): Long-Term Effectiveness and Safety Outcomes. JAMA.