Child and adolescent depression: short-term treatment effectiveness and long-term opportunities

As with adult major depressive disorder (MDD), child and adolescent MDD is characterized as a common, chronic and recurrent disorder. It is also associated with short- and long-term functional impairment, morbidity, and mortality. Effective treatments, both psychotherapeutic and pharmacotherapeutic, are available for the short-term treatment and management of youth with MDD. However, to date, there are no data on the long-term treatment and management of children and adolescents with MDD and how long-term treatment may affect the outcomes of either high-risk or already affected youth. Understanding the long-term consequences of MDD during youth is as important as understanding how to treat a single episode of depression. Available data on the pharmacotherapeutic and psychotherapeutic options are discussed. In general, tricyclic antidepressants (TCAs) are not as effective for the treatment of youth with MDD as adults with MDD. The selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in children and adolescents with MDD and non-obsessive compulsive anxiety disorders. The serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine XR, has been shown to be effective for the treatment of generalized anxiety disorder in children and adolescents. Understanding the long-term clinical consequences of depressive disorders in youth may provide opportunities for better intervention across the clinical course of illness. Early recognition, diagnosis and adequate treatment of 'high-risk' youth with subsyndromal depressive symptoms, treatment of acute episodes of depression to prevent 'kindling', and aggressive prophylaxis have the potential to improve the mental health of youth throughout their lives.