Juvenile-onset major depression includes childhood- and adolescent-onset depression and may be heterogeneous

Division of Clinical and Genetic Epidemiology, College of Physicians and Surgeons of Columbia University and the New York State Psychiatric Institute, 1051 Riverside Dr, Unit 24, New York, NY 10032, USA.
Archives of General Psychiatry (Impact Factor: 13.75). 04/2002; 59(3):223-4. DOI: 10.1001/archpsyc.59.3.223
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    ABSTRACT: Background Current guidelines for treatment-resistant depression in adolescents remain inadequate. This study aimed to systematically review the management of treatment-resistant depression in adolescent patients.Methods We conducted an electronic database search of PUBMED, EMBASE, Cochrane, Web of Science and PsycINFO for studies with adolescent treatment-resistant depression published up to January 2014. Treatment-resistant depression was defined as failure to respond to at least one course of psychological or pharmacological treatment for depression with an adequate dosage, duration, and appropriate compliance during the current illness episode. The Cochrane risk-of-bias method was used to assess the quality of randomized controlled trials. A meta-analysis of all active treatments was conducted.ResultsEight studies with 411 depressed adolescents that fit predetermined criteria investigated pharmacological treatments and psychotherapies. Six were open-label studies, and two were randomized controlled trials. The overall response rate for all active treatments investigated was 46% (95% CI 33 to 59; N¿=¿411) with a moderately high degree of heterogeneity (I2¿=¿76.1%, 95% CI¿=¿47%-86%). When only the two randomized trials were included, the overall response rate of active treatment was 53% (95% CI¿=¿38-67; N¿=¿347). In these randomized trials, SSRI therapy plus CBT was significantly more effective than SSRI therapy alone, while amitriptyline was not more effective than placebo.Conclusions Approximately half of the adolescents who presented with treatment-refractory depression responded to active treatment, which suggests that practitioners should remain persistent in managing these challenging cases. The combination of antidepressant medication and psychotherapy should be recommended for adolescents who present with treatment-resistant depression.
    BMC Psychiatry 11/2014; 14(1):340. DOI:10.1186/s12888-014-0340-6 · 2.24 Impact Factor
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    ABSTRACT: Intracontinental elevated plateaus remain geomorphologic features which are poorly studied. Their genesis requires a coupling between climate and deformation. The Fish River canyon (southern Namibia), the second largest canyon of the Earth, carved the South-African plateau on 550m along 65km. This study reveals that the upper and the lower segments are shaped by NE–SW and north-south grabens, respectively. These deformations increased the meandering and the vertical incision mainly in the lower canyon. However the river main trend was not drastically modified attesting that the river was ancient and that the rate of the vertical displacement was slow compared to the erosion rate. The main incision occurred during a NW–SE stretching of Plio-Pleistocene. These stretching episodes belong to two deformation phases previously poorly described in the South-African plateau. These widespread stretching phases are interpreted as a result of deep mantle dynamics affecting the inner African continent.
    Comptes Rendus Geosciences 07/2011; 343(7):478-485. DOI:10.1016/j.crte.2011.07.003 · 1.70 Impact Factor