Pharmacological and cognitive-behavioral approaches in the treatment of childhood depression: A review and critique

Depression in childhood is a neglected research area although studies have improved in quality and increased in quantity in recent years. Pharmacological and cognitive-behavioral therapies of depression in prepubertal children have been among those most commonly utilized. A review of research examining these therapies and the etiological models of childhood depression from which they are derived is presented. The efficacy of antidepressants has not been consistently demonstrated in double-blind, placebo-controlled trials. Recent pharmacological studies have utilized improved methodology but could benefit from broader assessment of psychosocial functioning, examination of the clinical impact of safety concerns, and attention to the family context of the disorder. An empirical basis for cognitive-behavioral theories is forming but the efficacy of associated therapies has not been consistently demonstrated due to the scarcity of studies and their use of methodology which may limit the generality of findings to clinical settings. The theoretical focus on the family, though empirically supported, has not been translated into cognitive-behavioral therapies for childhood depression. Family-focused treatment components warrant primary consideration given the living situation of depressed children and findings concerning parent-child interactions and parental depression in their families.