Depression is a common, often undertreated mental health for children and adolescents across the country.
Front line treatments are well known, and include:
- various forms and types of psychotherapies (individual and/or family, DBT, IPT, etc.),
- medications such as the selective serotonin re-uptake inhibitors (SSRIs), selective norepinephrine uptake inhibitors (SNRIs), and others, and
- various supportive interventions, such as school supports and increasing social activities.
Each of the above interventions have established benefits (and limitations) but the general consensus is that multi-modal interventions, where indicated and as feasible, are appropriate approaches in treatment of depressive (and most other) disorders. When depression presents with mild to modest levels of symptoms, skillful evaluation and psychotherapeutic interventions are typically recommended as the first of these first line therapies to be suggested.
When presenting symptoms are more profound or when psychotherapy and supportive services are not having desired impact, consideration should be given to the initiation of psychopharmacologic intervention(s) in conjunction with ongoing outpatient services. When presentations include concerns about potential harm, referral to a higher level of care need to be considered.
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Supplemental treatment interventions of note: Following is a brief discussion of some other complementary and/or alternative interventions that have evolving, but generally favorable (and, at worst, no major negative) evidence of potential efficacy that can be considered for implementation for patients and/or parents seeking to utilize them as supplemental interventions.
- Vitamin D deficiency is a known risk factor for depression but use of Vitamin D in depressed patients has generally proved challenging to affirm as of definitive benefit across all patients and blood levels can vary considerably across the population. This said, multiple studies have looked at the role of vitamin for adolescents with depression (Libuda et al., 2020; Focker et al., 2018), and Libuda et al. found in a randomized control trial that youth with Vitamin D deficiency and depression treated with 2640 IU of Vit D3 per day had significant improvement in parental ratings of depressive symptoms. More studies are needed, but this data suggests that offering supplemental treatment for youth with suspected vitamin D deficiency with depression may be worthwhile.
- Exercise, Yoga and Meditation (Cullen et al., 2019), not surprisingly, is generally believed to have a role in the augmenting treatment of depression, and preliminary data is positive. More research is certainly required, but these elements fit in well with the theoretical underpinnings of cognitive behavioral therapy, and current perspectives of health and wellness. It makes sense to encourage adolescents to take advantage of opportunities for the activities.
- Fish Oil, or Omega-3 fatty acids are also being studied. While there is not strong evidence for the role of Fish Oil as a specific treatment, there is ongoing investigation (Haberling et al., 2019). We expect there to be more interest and information in this in the upcoming years.
Altering Diet, with attention to specific supplements may play a role in the future (Cullen et al., 2019). Currently data is preliminary
Cullen, K. R., Padilla, L. E., Papke, V. N., & Klimes-Dougan, B. (2019). New Somatic Treatments for Child and Adolescent Depression. Current treatment options in psychiatry, 6(4), 380–400. https://doi.org/10.1007/s40501-019-00194-8
Häberling, I., Berger, G., Schmeck, K., Held, U., & Walitza, S. (2019). Omega-3 Fatty Acids as a Treatment for Pediatric Depression. A Phase III, 36 Weeks, Multi-Center, Double-Blind, Placebo-Controlled Randomized Superiority Study. Frontiers in psychiatry, 10, 863. https://doi.org/10.3389/fpsyt.2019.00863
Libuda L, Timmesfeld N, Antel J, Hirtz R, Bauer J, Führer D, Zwanziger D, Öztürk D, Langenbach G, Hahn D, Ring S, Peters T, Hinney A, Bühlmeier J, Hebebrand J, Grasemann C, Föcker M. Effect of vitamin D deficiency on depressive symptoms in child and adolescent psychiatric patients: results of a randomized controlled trial. Eur J Nutr. 2020 Dec;59(8):3415-3424. doi: 10.1007/s00394-020-02176-6. Epub 2020 Feb 27. PMID: 32108263; PMCID: PMC7669774.
Föcker, M., Antel, J., Grasemann, C., Führer, D., Timmesfeld, N., Öztürk, D., Peters, T., Hinney, A., Hebebrand, J., & Libuda, L. (2018). Effect of an vitamin D deficiency on depressive symptoms in child and adolescent psychiatric patients – a randomized controlled trial: study protocol. BMC psychiatry, 18(1), 57. https://doi.org/10.1186/s12888-018-1637-7