Both medication and psychological treatments have been successfully employed with children. Currently, there are four main classes of antidepressants that may be prescribed to youths: tricyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), and second-generation antidepressants. The antidepressants act on the monoamine neurotransmitter system, more specifically the neurotransmitters acetylcholine, norepinephrine, serotonin, and to a lesser extent dopamine. Antidepressant medications influence the metabolization and/or reuptake of the neurotransmitters producing increased levels of functionally available neurotransmitters. Most antidepressants have a broad spectrum effect, influencing the metaboliza-tion and/or reuptake of acetylcholine, norepinephrine, serotonin, and dopamine. A few are more focused, targeting specific brain monoamine systems. Current research indicates that SSRI treatments are beneficial for many depressed youngsters due to their efficacy, safety profile, and fewer reported side effects (Ambrosini, Emslie, Greenhill, Kutcher, & Weller, 1995). The presence and types of comorbid conditions are important determinants in choosing an appropriate medication. The recommended length of a medication trial is 6 to 10 weeks. If the medication does not show results during this period, then another antidepressant or an augmentation strategy with a different class of medications may be initiated. In a successful medication regimen, the recommended duration of treatment ranges from 2 months to 2 years.
Research has also supported the efficacy of cognitive-behavioral treatments for depressed youths. Cognitive-behavioral interventions are time-limited, structured interventions designed to change the depressed youngster's maladaptive thinking, behavior, and coping patterns. The child and therapist form a collaborative team in which the child is taught emotion regulation skills, coping skills, so cial skills, problem solving, and strategies for identifying and altering negative thoughts. The overall treatment goal is changing the individual's basic rules for interpreting daily interactions. Caregivers or the entire family may be included in the treatment program.
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