Exercise in the Prevention and Treatment of Adolescent Depression: A Promising but Little Researched Intervention
Andrea L. Dunn, PhD; Philippe Weintraub, MD
Andrea L. Dunn, PhD; Philippe Weintraub, MD
Abstract:
Despite a dramatic increase in the number of treatment studies for adolescent major depressive disorder in the past 15 years, the majority being clinical trials of medications and cognitive behavioral therapy, response rates have been modest and remission rates low. Moreover, most positive responders posttreatment have many residual symptoms, significant functional impairment, and high rates of relapse. There is a need for the development of new, more effective interventions to treat this severe, chronic condition that usually persists into adulthood with poor long-term outcomes. Findings from preliminary treatment studies suggest that exercise may have the potential to be efficacious as a monotherapy or as part of a combined treatment for adolescent major depressive disorder.
Despite a dramatic increase in the number of treatment studies for adolescent major depressive disorder in the past 15 years, the majority being clinical trials of medications and cognitive behavioral therapy, response rates have been modest and remission rates low. Moreover, most positive responders posttreatment have many residual symptoms, significant functional impairment, and high rates of relapse. There is a need for the development of new, more effective interventions to treat this severe, chronic condition that usually persists into adulthood with poor long-term outcomes. Findings from preliminary treatment studies suggest that exercise may have the potential to be efficacious as a monotherapy or as part of a combined treatment for adolescent major depressive disorder.
This review summarizes the findings and analyzes the design flaws of randomized trials of exercise to treat adolescent depression, offering recommendations on how to design more methodologically sound studies with an emphasis on subjectselection criteria; issues related to control conditions , types of diagnostic interviews, and measures needed to establish the diagnosis of depression; types of exercise treatments; and appropriate outcome measures. Future studies of exercise to treat and prevent adolescent major depressive disorder need to be comparable to state-of-the-art treatment studies of pharmacotherapy and cognitive behavioral therapy in this population to more accurately determine its efficacy and potential public health benefits.
Introduction
Adolescent depression is a major public health problem in the United States and throughout the world. [1-11 ] Major depressive disorder (MDD) in teens is common with point prevalence rates of 3% to 9%.[12- 15] In the United States, it is estimated that by the time adolescents reach adulthood, 25% of them will have experienced at least one episode of MDD.[2] Recent studies show a secular increase in its prevalence, [16 ] and many serious youth problems such as suicide,[17 ,18 ] substance abuse,[19 ] cigarette smoking,[20 ] teen pregnancy,[21 ] impaired psychosocial functioning,[22] and school failure[23 ] have been linked to untreated depression.
Moreover, adolescent depression has been shown to be a chronic condition persisting into adulthood with multiple recurrences and significant morbidity.[24 ,25 ] Therefore, successful treatment of teen depression is important not only in reducing the suffering, morbidity, and mortality from the disorder but also in preventing the development of other adverse long-term psychosocial and health outcomes.
Most of the research on this illness has been for adolescent MDD, but even subsyndromal depression is linked to significant functional impairment and an increased risk of developing MDD. For example , in a prospective study of more than 2000 adolescents,[22] teens with subthreshold depressive symptoms showed significantly greater functional impairment compared with teens diagnosed with conduct disorder . Thus, adolescents with subclinical symptoms of depression represent an equally important intervention target to prevent worsening of symptoms and to improve functional outcomes.[26 -28 ]
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Introduction
Adolescent depression is a major public health problem in the United States and throughout the world. [1-11 ] Major depressive disorder (MDD) in teens is common with point prevalence rates of 3% to 9%.[12- 15] In the United States, it is estimated that by the time adolescents reach adulthood, 25% of them will have experienced at least one episode of MDD.[2] Recent studies show a secular increase in its prevalence, [16 ] and many serious youth problems such as suicide,[17 ,18 ] substance abuse,[19 ] cigarette smoking,[20 ] teen pregnancy,[21 ] impaired psychosocial functioning,[22] and school failure[23 ] have been linked to untreated depression.
Moreover, adolescent depression has been shown to be a chronic condition persisting into adulthood with multiple recurrences and significant morbidity.[24 ,25 ] Therefore, successful treatment of teen depression is important not only in reducing the suffering, morbidity, and mortality from the disorder but also in preventing the development of other adverse long-term psychosocial and health outcomes.
Most of the research on this illness has been for adolescent MDD, but even subsyndromal depression is linked to significant functional impairment and an increased risk of developing MDD. For example , in a prospective study of more than 2000 adolescents,[22] teens with subthreshold depressive symptoms showed significantly greater functional impairment compared with teens diagnosed with conduct disorder . Thus, adolescents with subclinical symptoms of depression represent an equally important intervention target to prevent worsening of symptoms and to improve functional outcomes.[26 -28 ]
DOWNLOAD COMPLETE PDF HERE
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