Major depression that develops in childhood is a strong predictor of long-term struggles with mental health disorders. Approximately 2–8% of children and adolescents are diagnosed with major depression, and 50–75% of these suffer recurring episodes of the disease. Relapse is a serious and valid concern in the treatment of depression, regardless of age. In children especially, early and strong intervention is essential for adequate treatment of depression. The standard treatment for depression involves a pharmaceutical intervention, regular sessions of cognitive therapy, and continuation of medication for several years thereafter, often referred to as the maintenance period.
The antidepressant medication Prozac (fluoxetine) is considered an appropriate first treatment for depression in children and adolescents. However, there is a small risk of suicidal thoughts or behavior in patients under the age of 24. The attending physician and guardians must be mindful of this risk and report any unusual behavior, such as withdrawal or self-harm. Fortunately, in the vast majority of cases this side effect is not present. Prozac is classified as a selective serotonin reuptake inhibitor, the newest category of antidepressants, and is generally accepted as a safe and well-tolerated medication for children and adolescents.
In a clinical experiment with more than 100 children aged 7-18, Prozac was tested against placebo to determine its effectiveness at delaying or preventing relapse of major depression. All participants received 12 weeks of treatment with Prozac. Those who experienced a remission of depression were then randomized into continuation groups. The control group received placebo while the experimental group continued to receive Prozac. The test ran for three years while regular psychiatric interviews assessed the progress of each participant. Researchers were primarily interested in episodes of relapse. They theorized that the experimental group would experience fewer episodes of relapse and a longer delay between the beginning of continuation therapy and the onset of a depressive episode.
Researchers had their theories largely confirmed by the end of the three-year study. Children and adolescents in the experimental group experienced far fewer incidences of relapse. Likewise, the time to relapse was much longer in the experimental group compared with the control group. Participants who had some residual symptoms at the end of 12 weeks were also more prone to relapse. For reasons not understood, boys responded slightly better overall than girls did. In general, the risk of relapse was still higher than one would like. Prozac as a maintenance treatment offers an improvement over no treatment at all, but depression remains stubbornly difficult to vanquish in any permanent way.
- Emsli, G.J., Kennard, B.D., Mayes, T.L., Nightingale-Teresi, J., Carmody, T., Hughes, C.W., Rush, J., et al. (2008). Fluoxetine versus placebo in preventing relapse of major depression in children and adolescents. American Journal of Psychiatry, 165, (4), 459-467.
- National Center for Biotechnology Information. (n.d.). Fluoxetine. PubMed Health. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/
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