Depression Research at NIMH - Depression Research

Written by NIMH

Until recently, there were limited data on the safety and efficacy of antidepressant medications in children and adolescents. The use of antidepressants in this age group was based on adult standards of treatment. A recent NIMH-funded study supported fluoxetine, an SSRI, as a safe and efficacious medication for child and adolescent depression. The response rate was not as high as in adults, however, emphasizing the need for continued research on existing treatments and for development of more effective treatments, including psychotherapies designed specifically for children. Other complementary studies in the field are beginning to report similar positive findings in depressed young people treated with any of several newer antidepressants. In a number of studies, TCAs were found to be ineffective for treating depression in children and adolescents, but limitations of the study designs preclude strong conclusions.

NIMH is committed to developing an infrastructure of skilled researchers in the areas of child and adolescent mental health. In 1995, NIMH co-sponsored a conference that brought together more than 100 research experts, family and patient advocates, and representatives of mental health professional organizations to discuss and reach consensus on various recommendations for psychiatric medication research in children and adolescents. Outcomes of this conference included awarding additional funds to existing research grants to study psychotropic medications in children and adolescents and establishing a network of Research Units of Pediatric Psychopharmacology (RUPPs). Recently, a large, multi-site, NIMH-funded study was initiated to investigate both medication and psychotherapeutic treatments for adolescent depression.

Continuing to address and resolve the ethical challenges involved with clinical research on children and adolescents is an NIMH priority.

Older Adults and Depression

In a given year, between one and two percent of people over age 65 living in the community, i.e., not living in nursing homes or other institutions, suffer from major depression and about two percent have dysthymia. Depression, however, is not a normal part of aging. Research has clearly demonstrated the importance of diagnosing and treating depression in older persons. Because major depression is typically a recurrent disorder, relapse prevention is a high priority for treatment research. As noted previously, a recent NIMH-supported study established the efficacy of combined antidepressant medication and interpersonal psychotherapy in reducing depressive relapses in older adults who had recovered from an episode of depression.

Additionally, recent NIMH studies show that 13 to 27 percent of older adults have subclinical depressions that do not meet the diagnostic criteria for major depression or dysthymia but are associated with increased risk of major depression, physical disability, medical illness, and high use of health services. Subclinical depressions cause considerable suffering, and some clinicians are now beginning to recognize and treat them.

Suicide is more common among the elderly than in any other age group. NIMH research has shown that nearly all people who commit suicide have a diagnosable mental or substance abuse disorder. In studies of older adults who committed suicide, nearly all had major depression, typically a first episode, though very few had a substance abuse disorder. Suicide among white males aged 85 and older was nearly six times the national U.S. rate (65 per 100,000 compared with 11 per 100,000) in 1996, the most recent year for which statistics are available. Prevention of suicide in older adults is a high priority area in the NIMH prevention research portfolio.

Alternative Treatments

There is high public interest in herbal remedies for various medical conditions including depression. Among the herbals is hypericum or St. John's wort, promoted as having antidepressant effects. Adverse drug interactions have been reported between St. John's wort and drugs used to treat HIV infections as well as those used to reduce the risk of organ transplant rejection. In general, preparations of St. John's wort vary significantly. No adequate studies have been done to determine the antidepressant efficacy of the herbal. Consequently, the NIMH has co-sponsored the first large-scale, multi-site, controlled study of St. John's wort as a potential treatment for depression. Results from this study are expected in 2001.