Mark A. Reinecke, Ph.D.
Northwestern University
Division of Psychology
Department of Psychiatry & Behavioral Sciences
Northwestern University Medical School
710 N. Lakeshore Drive, Suite 12-1205
Chicago, IL. 60611
(312) 908-1465
Depression during adolescence is an important social problem. Recent studies suggest that 5% to 8% of adolescents
experience clinically severe levels of depression at any given time, and that a much larger percentage demonstrate
subclinical symptoms of the disorder over the course of the year. The disorder is chronic and recurrent, and is associated
with a range of social, academic and emotional difficulties. Depressed teens are more likely to develop alcohol and
substance abuse problems and to have problems with family members and peers. Moreover, depression puts teenagers at
risk for suicide and aggression. The large majority of depressed teens do not receive effective care.
Controlled outcome studies indicate that two forms of treatment---Fluoxetine and Cognitive-Behavioral Therapy
(CBT)---can be effective for treating depression among adolescents. The TADS project is a multisite, federally funded
research study designed to determine the relative effectiveness and the stability of gains. Patients are randomly assigned to
one of four conditions--CBT alone, Prozac alone, Combination of CBT and Prozac, or Placebo. A flexible, manualized
CBT treatment protocol, based on work by Brent, Beck, and Lewinsohn, is used. A "modularized" approach, in which
adolescents learn specific cognitive and behavioral skills based upon their individual needs, is advocated. Treatment
modules focus on goal setting, mood monitoring, behavioral activation, problem-solving, relaxation training, identification
of maladaptive thoughts, formulating counter-thoughts, cognitive distortions, social skills, assertiveness, communication
and negotiation skills, and relapse prevention. In addition, treatment can address family attachment, parental expectations
and attributions, and family communication patterns. The medications are administered in a standardized manner based
upon objectively evaluated clinical improvement.
The results of a pilot study using the TADS treatment protocol (combination treatment) indicated that better than 70% of
teenagers showed "significant improvement" within 6 weeks. Specific treatment procedures will be described, and the
implications of this approach for the treatment of depressed teens will be discussed.
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