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Article Excerpt
Interpersonal psychotherapy (IPT) is a brief, time-limited therapy originally developed for use with adults diagnosed with major depression. During the past decade, IPT has been modified for use with many different age groups including adolescents diagnosed with depression. A number of empirical investigations have considered the use of interpersonal psychotherapy for adolescents (IPT-A) in the treatment of adolescents diagnosed with depression. This article provides mental health counselors with information about the prevalence and course of adolescent depression, other empirically tested treatments for adolescent depression, an explanation of IPT-A treatment protocol, and results of outcome studies on the effectiveness of IPT-A. Suggestions for future research investigations with IPT-A are offered.
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Depressive disorders among adolescents are not uncommon. The onset of major depression often occurs in adolescence and by late adolescence the prevalence rate for depressive disorders is estimated between 6% and 9% (Kutcher & Marton, 1996). The onset for major depressive disorders (MDD) appears most likely between the ages of 13 and 19 (Birmaher, Ryan, & Williamson, 1996). As with adults, females tend to be impacted by these disorders at the rate of 2:1 (Mueller & Orvaschel, 1997). Depressive symptomology in adolescence is also the most significant factor in predicting depressive symptomology in adulthood (Mufson & Moreau, 1997). Research suggests that depression may have more harmful effects for adolescents than for adults (Schraedley, Gotlib, & Hayward, 1999). These statistics reflect the need for intentional and culturally appropriate treatment developed specifically to meet the needs of adolesents diagnosed with depression. The question becomes, What treatment modalities can mental health counselors use to best meet this need?
Diagnostically, adolescent depression appears to mimic the characteristics of adult depression (Sands, 1998). Both adolescents and adults who are depressed appear to have chronic, recurring episodes, psychosocial impairments, disturbances in sleep and appetite, suicidal ideations, difficulties focusing, and depressed mood (Mufson & Moreau, 1997).
Some key clinical characteristics, however, distinguish adolescent depressive symptomology from that of adults (Birmaher, Ryan, Williamson, Brent, et al., 1996). Adolescents who are depressed tend to exhibit more helplessness, despair, lack of pleasure, hypersomia, and changes in weight (Birmaher et al., 1996). Depressive disorders in adolescence also tend to be more episodic, with stages of depression followed by stages of better functioning (Mufson & Moreau, 1997). Adolescent depression is characterized by significant impairments in academic performance and relationships with others (Birmaher, Ryan, Williamson, Brent, et al., 1996). Depressive symptomology among adolescents may be associated with future substance abuse and unwed pregnancy (Stanard, 2000). Eating disorders and violence may also be associated with adolescent onset depression (Modrican-McCarthy & Dalton, 1996). The ultimate violence towards oneself, suicide, is the most alarming difference between adolescent and adult depression. Research indicates that adolescents tend to have higher rates of lethality in their suicide attempts (Birmaher, Ryan, Williamson, Brent, et al., 1996). Among successful adolescent suicides, depression is the most common diagnosis (Kutcher & Marton, 1996).
Despite evidence that major depression is prevalent among the adolescent population, little empirical attention has been given to treatment with adolescents (Mufson et al., 1994). In comparison to the outcome studies related to treating adults diagnosed with major depression, there are few studies examining the effectiveness of treatment for adolescents with depression (Mufson, Weissman, Moreau, Garfinkel, 1999).
Psychopharmacological and cognitive-behavioral treatment approaches to the treatment of adolescents with depression have received some attention. The effectiveness of several antidepressants with depressed adolescents has been explored. However, these studies failed to demonstrate efficacy and have been criticized for poor research design (Mufson et al., 1999). Monoamine oxidase inhibitors (MAOIs) have been shown to be effective in the treatment of adult depression, but have not received a great deal of empirical attention for the treatment of adolescent depression (Kutcher & Marton, 1996). The use of tricyclic antidepressants in the treatment of adolescent depression has been explored in both open and controlled studies, but these studies have failed to demonstrate efficacy (Kutcher & Marton, 1996). Investigations of the use of serotonin-specific reuptake inhibitors (SSRI) have shown more promise in treating adolescent depression, but these studies have only been completed as open clinical trials (Kutcher & Marton, 1996). More research is needed examining the use of antidepressant medication in the treatment of depressed adolescents (Mufson, Moreau, & Weissman, 1996).
Scientifically sound studies that consider the effectiveness of psychotherapies with this population are also lacking (Harrington, Whittaker, & Shoebridge, 1998). Studies have not met minimum scientific standards such as the use of homogeneous samples and random assignments to experimental and control groups (Mufson & Moreau, 1997). Psychotherapies for the treatment of adolescent depression have also been studied less extensively than somatic treatments (Kutcher & Marton, 1996).
The trend in counseling has been to adapt approaches for the treatment of adults with depression to adolescents (Kutcher & Marton, 1996). The treatments for adults that are commonly used for adolescents who are depressed include cognitive, psychodynamic, behavioral, and family approaches (Mufson & Moreau, 1997). These strategies, based on theoretical and clinical perspectives of adolescent treatment, seek to decrease depressive symptomology and increase psychosocial functioning of the adolescent (Mufson & Moreau, 1997).
There has been some empirical attention paid to the use of individual and group cognitive behavior therapy (CBT) with adolescents who are depressed (Mufson et al., 1999). Overall, the treatment outcomes for depressed adolescents have not been as promising as they are for adults (Kutcher & Marton, 1996). The empirical data available for CBT appears to suggest that CBT is more effective in treating adolescents with less intense depression and for those who are functioning better at intake (Kutcher & Marton, 1996).
Psychodynamic approaches to the treatment of adolescent depression have received little empirical investigation (Kutcher & Marton, 1996). There are no studies that meet minimum scientific standards available for the use of psychodynamic approaches with this population (Kutcher & Marton, 1996). One review did consider the use of this approach with adolescent depression and found it to be lacking in theoretical and procedural thoroughness (Kutcher & Marton, 1996).
Strict behavioral approaches to the treatment of adolescent depression have also not received much empirical...
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