DÄ internationalArchive19/2008Depression in Children and Adolescents: In Reply

Correspondence

Depression in Children and Adolescents: In Reply

Dtsch Arztebl Int 2008; 105(19): 364. DOI: 10.3238/arztebl.2008.0364

Mehler-Wex, C

LNSLNS We fully agree with the points made by Calia. As the relative intensity of the different symptoms of depressive disorders in children and adolescents varies with age, it is particularly important to pay attention to differential diagnosis and comorbidities. Clinical psychiatrists have had favorable results in treating children and adolescents with carefully selected and monitored pharmacotherapy.

The studies mentioned by Windaus do not provide more than level of evidence III for psychodynamic psychotherapy for depressive disorders in children and adolescents. One criticism of the quality of these studies is that they include a wide range of very different diagnoses, which are often only partially depression, are often "only" dysthymia, and which include many comorbid disorders. Moreover, the "primary outcome" is not adequately defined and depression-specific scales are hardly used. Thus the conclusions about disorder-specific efficacy are restricted.

It must also be remembered that the high rates of spontaneous remission, the effect of non-specific advice on depression and the placebo response rates from 30 to 60% can confound results with all forms of treatment (see (1) and (2)). This makes it evident how difficult it is to evaluate the mono-causal efficacy of individual therapeutic strategies. In any case, the level of evidence does not allow the conclusion that specific forms of therapy will or will not work for individual patients. In this context, Windaus's letter may at least be seen as a call for more research in this area.
DOI: 10.3238/arztebl.2008.0364


Prof. Dr. med. Claudia Mehler-Wex
Dr. med. Michael Kölch
Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie
Steinhövelstr. 5
89075 Ulm
Germany

Conflict of interest statement
The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Goodyer et al.: Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial. BMJ 2007; 21; 335: 142 MEDLINE
2.
Wilkinson und Goodyer: The effects of cognitive-behavioural therapy on mood-related ruminative response style in depressed adolescents. Child Adolesc Psychiatr Mental Health 2008; 2: 3. MEDLINE
1. Goodyer et al.: Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial. BMJ 2007; 21; 335: 142 MEDLINE
2. Wilkinson und Goodyer: The effects of cognitive-behavioural therapy on mood-related ruminative response style in depressed adolescents. Child Adolesc Psychiatr Mental Health 2008; 2: 3. MEDLINE