Recent developments in the treatment of major depressive disorder in children and adolescents

Psychological interventions for depression in children and adolescents: A bibliometric analysis

BACKGROUND

Depression has gradually become a common psychological disorder among children and adolescents. Depression in children and adolescents affects their physical and mental development. Psychotherapy is considered to be one of the main treatment options for depressed children and adolescents. However, our understanding of the global performance and progress of psychological interventions for depression in children and adolescents (PIDCA) research is limited.

AIM

To identify collaborative research networks in this field and explore the current research status and hotspots through bibliometrics.

METHODS

Articles and reviews related to PIDCA from January 2010 to April 2023 were identified from the Web of Science Core Collection database. The Charticulator website, CiteSpace and VOSviewer software were used to visualize the trends in publications and citations, the collaborative research networks (countries, institutions, and authors), and the current research status and hotspots.

RESULTS

Until April 16, 2023, 1482 publications were identified. The number of documents published each year and citations had increased rapidly in this field. The United States had the highest productivity in this field. The most prolific institution was the University of London. Pim Cuijpers was the most prolific author. In the context of research related to PIDCA, both reference co-citation analysis and keywords co-occurrence analysis identified 10 research hotspots, including third-wave cognitive behavior therapy, short-term psychoanalytic psychotherapy, cognitive behavioral analysis system of psychotherapy, family element in psychotherapy, modular treatment, mobile-health, emotion-regulation-based transdiagnostic intervention program, dementia risk in later life, predictors of the efficacy of psychological intervention, and risks of psychological intervention.

CONCLUSION

This bibliometric study provides a comprehensive overview of PIDCA from 2010 to present. Psychological intervention characterized as psychological-process-focused, short, family-involved, modular, internet-based, emotion-regulation-based, and personalized may benefit more young people.

Practitioner Review: Signposts for Enhancing Cognitive-Behavioral Therapy for School Refusal in Adolescence

Factors associated with adolescent development influence the occurrence and presentation of school refusal (SR). Cognitive-behavioral therapy (CBT) manuals for the treatment of SR account for these developmental issues to varying degrees. Some multimodal treatments aim to address the complexity of adolescent SR by incorporating interventions alongside CBT, such as medication, inpatient treatment, and educational support in a special setting. However, CBT manuals and multimodal treatments appear to fail to help approximately one-third to two-thirds of adolescents, with respect to achieving regular school attendance. This paper provides an overview of suggestions in the literature for improving treatment for SR, with a focus on adolescent SR. Seven signposts emerge from the literature, namely, increased number or frequency of sessions, greater attention to social anxiety disorder and social functioning, greater attention to depression, greater attention to emotion regulation, careful consideration of the role of parents, greater attention to parent-adolescent communication and problem-solving, and the use of alternative educational settings. Professionals may find these signposts helpful when planning and delivering treatment for SR in adolescents. Research is needed to determine the benefit of including one or more of these adaptations alongside an existing SR treatment.

The comparative effectiveness of antidepressants for youths with major depressive disorder: a nationwide population-based study in Taiwan

Background:

Guidelines recommend fluoxetine as a first-line medication for youths diagnosed with major depressive disorder (MDD). However, little is known about the long-term effectiveness of different antidepressants in juveniles in the real world. This study aimed to compare the effectiveness of antidepressants in youths with MDD.

Methods:

Youths (<20 years old) with a diagnosis of MDD who were new users of antidepressants were selected from a nationwide population-based cohort in Taiwan between 1997 and 2013. We divided a total of 16,981 users (39.9% male; mean age: 16.6 years) into 10 different antidepressant groups (fluoxetine, sertraline, paroxetine, venlafaxine, citalopram, escitalopram, bupropion, fluvoxamine, mirtazapine and moclobemide). Regarding treatment outcomes (hospitalisation and medication discontinuation), Cox proportional hazards regression models were applied to estimate the hazards of such outcomes.

Results:

Compared with the youths treated with fluoxetine, the bupropion-treated group demonstrated lower rates of hospitalisation and discontinuation. Mirtazapine-treated group demonstrated a higher hospitalisation risk mainly when administered for single depressive episodes. Furthermore, patients treated with sertraline and fluvoxamine had higher discontinuation rates. Among the younger teenage subgroups (< 16 years), significantly higher rates of discontinuation were observed in those treated with sertraline, escitalopram and fluvoxamine. Among the older teenage subgroups (⩾ 16 years), bupropion was superior to fluoxetine in preventing hospitalisation and discontinuation.

Conclusion:

We concluded that bupropion might surpass fluoxetine with regard to hospitalisation prevention and drug therapy maintenance among youths with MDD, while mirtazapine users demonstrated a higher hospitalisation risk. Our findings might serve as a reference for clinicians in future studies.

Potential application of liposomal nanodevices for non-cancer diseases: an update on design, characterization and biopharmaceutical evaluation

Liposomes, lipid-based vesicular systems, have attracted major interest as a means to improve drug delivery to various organs and tissues in the human body. Recent literature highlights the benefits of liposomes for use as drug delivery systems, including encapsulating of both hydrophobic and hydrophilic cargos, passive and active targeting, enhanced drug bioavailability and therapeutic effects, reduced systemic side effects, improved cargo penetration into the target tissue and triggered contents release. Pioneering work of liposomes researchers led to introduction of long-circulating, ligand-targeted and triggered release liposomes, as well as, liposomes containing nucleic acids and vesicles containing combination of cargos. Altogether, these findings have led to widespread application of liposomes in a plethora of areas from cancer to conditions such as cardiovascular, neurologic, respiratory, skin, autoimmune and eye disorders. There are numerous review articles on the application of liposomes in treatment of cancer, which seems the primary focus, whereas other diseases also benefit from liposome-mediated treatments. Therefore, this article provides an illustrated detailed overview of liposomal formulations, in vitro characterization and their applications in different disorders other than cancer. Challenges and future directions, which must be considered to obtain the most benefit from applications of liposomes in these disorders, are discussed.

Changes in cognitive distortions and affectivity levels in adolescent depression after acute phase fluoxetine treatment

INTRODUCTION

It is supposed that both antidepressants and psychotherapies work in a manner consistent with cognitive theories of depression when changing negative affective and cognitive distortions. This study evaluated changes in cognitive distortions (i.e. systematic misinterpretations of new information) and affectivity in adolescent major depressive disorder (MDD) after acute phase treatment with fluoxetine.

METHODS

Twenty-five adolescents (mean age 15.10 years (SD = 1.19); 17 (68%) females) with MDD receiving fluoxetine were followed for 8 weeks. Clinician rating scales of MDD and self-reports of cognitive distortions and affectivity were completed before and after the treatment.

RESULTS

Seven (28%) adolescents showed significant improvement in cognitive distortions, 11 (44%) showed a significant decrease in negative affect, and 15 (60%) showed a significant increase in positive affect. The responders to fluoxetine had significantly decreased level of negative affect (62.5%) and an increased level in positive affect (81.2%) compared to non-responders, whereas there were no differences between the two regarding changes in cognitive distortions.

CONCLUSIONS

Treatment with fluoxetine over 8 weeks led to reductions in cognitive distortions, with decreased negative and increased positive affect in adolescents with MDD. Improvements in affectivity levels closely corresponded to reductions in depressive symptoms and were greater than improvements in cognitive distortions.

Body weight status is not a predictive factor of depressive symptoms in Polish adolescents aged 13-18 years

Depression and unhealthy weight status are among the most common concerns in adolescent boys and girls. Research results on the relationship between depression and weight status are contradictory. The aim of the present study was to assess the association between body weight status and depressive symptoms among Polish adolescent boys and girls. The cross-sectional survey was carried out on adolescents attending lower and higher secondary schools located in three medium-sized cities and one big agglomeration in Poland. Anthropometric measurements, such as body height and weight, were performed. Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms. The total sample consisted of 624 boys and 910 girls aged 13-18 (the mean age was 16.4 ± 1.8) participated in the study. Of them, 73.3% had a healthy weight status, 12.9% were classified as thin, 11.4% were overweight and 2.5% were obese. The prevalence of depression based on BDI-II was 20.2% in boys and 34.9% in girls. The Kruskal–Wallis test revealed a lack of association between the body weight status and total scores of depressive symptoms after controlling for age (p=0.98 and p=0.4 for boys and girls, respectively). The multiple regression analysis revealed that gender and age differentiated the depressive symptoms (for gender: ß=0.19; SE=0.38; p<0.001 and for age: ß=0.05; SE=0.1; p<0.05). Age and gender explained 3.5% of the total variance of depressive symptoms. The study did not confirm the association between the body weight status and depression in adolescence.