Interpersonal Theory and Adolescents with Depression: Clinical Update.

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. ********** 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). …