Many significant advances are being made in treating depressed children and adolescents. Recent and ongoing research shows that newer antidepressants are effective in the acute treatment of depression in this group.

One recent study followed 200 adolescents who were given either fluoxetine or placebo. Patients who responded to the medication were randomly assigned to either continuation of the medicine or placebo. Of those assigned to placebo in the second round, 60% relapsed within 70 days--roughly the same period as the half-life of the medication. The adolescents on continuation therapy showed a relapse rate of only 30% and an average time to relapse of 180 days.

Dr. Emslie noted that although research data on the use of SSRIs are limited, the drugs are being widely prescribed to children. To help lessen this gap in physician knowledge, a conference was recently held to design a medication algorithm as an outline of suggested treatment methods. Dr. Emslie discussed the algorithm resulting from the conference.

Selective serotonin reuptake inhibitors (SSRIs) are suggested as the first-line treatment for this group of patients. If there is no response in four weeks, the doctor should consider using a second SSRI for a similar amount of time. Failure of a second newer antidepressant medication should be followed by a trial of one of the older antidepressants.

Dr. Emslie stressed that the objective of treatment should be remission, not just response. If the patient feels better but still has depressive symptoms, relapse is more likely.

Because questions regarding safety and efficacy of antidepressants are being answered, an increasing amount of research is being done on other therapies for depressed children. For example, studies are currently underway to look at the effectiveness of psychotherapy, both by itself and in conjunction with medication.