https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60322-5.pdf

Self-harm and suicide in adolescents.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60871-4.pdf

Depression in adolescence

This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice. J. Am. Acad. Child Adolesc. Psychiatry, 2007; 46(11):1503Y1526. Key Words: major depressive disorder, dysthymic disorder, evaluation, treatment, antidepressants, selective serotonin reuptake inhibitors, psychotherapy, practice parameter. Depressive disorders are often familial recurrent illnesses associated with increased psychosocial morbidity and mortality. Early identification and effective treatment may reduce the impact of depression on the family, social, and academic functioning in youths and may reduce the risk of suicide, substance abuse, and persistence of depressive disorders into adulthood. Evidencesupported treatment interventions have emerged in psychotherapy and medication treatment of childhood depressive disorders that can guide clinicians to improve outcomes in this population.

https://aacap.org/app_themes/aacap/docs/practice_parameters/depressive_disorders_practice_parameter.pdf

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

https://research.ncl.ac.uk/cargo-ne/Green%20et%20al%20Lancet%202010.pdf

Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial.

OBJECTIVE Evidence-based practice involves the consideration of efficacy and effectiveness, clinical expertise, and patient preference in treatment selection. However, patient preference for psychiatric treatment has been understudied. The aim of this meta-analytic review was to provide an estimate of the proportion of patients preferring psychological treatment relative to medication for psychiatric disorders. DATA SOURCES A literature search was conducted using PubMed, PsycINFO, and the Cochrane Collaboration library through August 2011 for studies written in English that assessed adult patient preferences for the treatment of psychiatric disorders. The following search terms and subject headings were used in combination: patient preference, consumer preference, therapeutics, psychotherapy, drug therapy, mental disorders, depression, anxiety, insomnia, bipolar disorder, schizophrenia, substance-related disorder, eating disorder, and personality disorder. In addition, the reference sections of identified articles were examined to locate any additional articles not captured by this search. STUDY SELECTION Studies that assessed preferred type of treatment and included at least 1 psychological treatment and 1 pharmacologic treatment were included. Of the 644 articles identified, 34 met criteria for inclusion. DATA EXTRACTION Authors extracted relevant data including the proportion of participants reporting preference for psychological or pharmacologic treatment. RESULTS The proportion of adult patients preferring psychological treatment was 0.75 (95% CI, 0.69-0.80), which was significantly higher than equivalent preference (ie, higher than 0.50; P < .001). Sensitivity analyses suggested that younger patients (P = .05) and women (P < .01) were significantly more likely to choose psychological treatment. A preference for psychological treatment was consistently evident in both treatment-seeking and unselected (ie, non-treatment-seeking) samples (P < .001 for both) but was somewhat stronger for unselected samples. CONCLUSIONS Aggregation of patient preferences across diverse settings yielded a significant 3-fold preference for psychological treatment. Given evidence for enhanced outcomes among those receiving their preferred psychiatric treatment and the trends for decreasing utilization of psychotherapy, strategies to maximize the linkage of patients to preferred care are needed.

Patient Preference for Psychological vs Pharmacologic Treatment of Psychiatric Disorders: A Meta-Analytic Review

Objective To determine whether a combination of a selective serotonin reuptake inhibitor (SSRIs) and cognitive behaviour therapy (CBT) together with clinical care is more effective in the short term than an SSRI and clinical care alone in adolescents with moderate to severe major depression. Design Pragmatic randomised controlled superiority trial. Setting 6 outpatient clinics in Manchester and Cambridge. Participants 208 adolescents, aged 11-17, with moderate to severe major or probable major depression who had not responded to a brief initial intervention. Adolescents with suicidality, depressive psychosis, or conduct disorder were included. Interventions 103 adolescents received an SSRI and routine care; 105 received an SSRI, routine care, and CBT. The trial lasted 12 weeks, followed by a 16 week maintenance phase. Main outcome measures Change in score on the Health of the Nation outcome scales for children and adolescents (primary outcome) from baseline with 12 weeks as the primary and 28 weeks as the follow-up end point. Secondary measures were change in scores on the mood and feelings questionnaire, the revised children9s depression rating scale, the children9s global assessment scale, and the clinical global impression improvement scale. Results At 12 weeks the treatment effect for the primary outcome was −0.64 (95% confidence interval −2.54 to 1.26, P=0.50). In a longitudinal analysis, there was no difference in effectiveness of treatment for the primary (average treatment effect 0.001, −1.52 to 1.52, P=0.99) or secondary outcome measures. On average there was a decrease in suicidal thoughts and self harm. There was no evidence of a protective effect of cognitive behaviour therapy on suicidal thinking or action. By 28 weeks, 57% were much or very much improved with 20% remaining unimproved. Conclusions For adolescents with moderate to severe major depression there is no evidence that the combination of CBT plus an SSRI in the presence of routine clinical care contributes to an improved outcome by 28 weeks compared with the provision of routine clinical care plus an SSRI alone. Trial registration Current Controlled Trials ISRCNT 83809224.

https://www.bmj.com/content/bmj/335/7611/142.full.pdf

Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial

Background Major depression is an important and costly problem among 
adolescents, yet evidence to support the provision of cost-effective 
treatments is lacking. Aims To assess the short-term cost-effectiveness of combined 
selective serotonin reuptake inhibitors (SSRIs) and 
cognitive–behavioural therapy (CBT) together with clinical care compared 
with SSRIs and clinical care alone in adolescents with major depression. Method Pragmatic randomised controlled trial in the UK. Outcomes and 
costs were assessed at baseline, 12 and 28 weeks. Results The trial comprised 208 adolescents, aged 11-17 years, with 
major or probable major depression who had not responded to a brief initial 
psychosocial intervention. There were no significant differences in outcome 
between the groups with and without CBT. Costs were higher in the group with 
CBT, although not significantly so ( P =0.057). Cost-effectiveness 
analysis and exploration of the associated uncertainty suggest there is less 
than a 30% probability that CBT plus SSRIs is more cost-effective than SSRIs 
alone. Conclusions A combination of CBT plus SSRIs is not more 
cost-effective in the short-term than SSRIs alone for treating adolescents 
with major depression in receipt of routine specialist clinical care.

/pdf/cost-effectiveness-of-selective-serotonin-reuptake-gyv9oyz6ke.pdf

Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive behavioural therapy in adolescents with major depression.

major depression: randomised controlled trial cognitive behaviour therapy in adolescents with and routine specialist care with and without Selective serotonin reuptake inhibitors (SSRIs)

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Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial

Cost-effectiveness of selective serotonin reuptake inhibitors and routine specialist care with and without cognitive behavioural therapy in adolescents with major depression.

major depression: randomised controlled trial cognitive behaviour therapy in adolescents with and routine specialist care with and without Selective serotonin reuptake inhibitors (SSRIs)