Relapse and Recurrence in Pediatric Depression

Depression is a chronic illness in children and adolescents that often leads to long-term difficulties with recurrent episodes of depression. As such, standard treatment must continue beyond acute symptom reduction to a chronic disease management model, such as those used in pediatric asthma and diabetes [103-105]. Within the chronic disease management model, treatment interventions are directed not only at the urgent or acute concern but also at the prevention of future problems. For example, with children with asthma, immediate attention is given to acute asthma attacks, but rather than simply treating that crisis alone, preventive treatments are provided to reduce or eliminate future asthma attacks. Lack of consistent efficacy in acute treatment studies has limited long-term prevention treatment research in pediatric depression. The impact of long-term treatments-psychosocial and pharmacologic-is currently unknown. The goals of treatment differ in the various stages. That is, in acute treatment, the focus is on symptom improvement, whereas in continuation and maintenance treatment, the focus is on preventing return of symptoms. Different treatments may be differentially effective in achieving these goals in the various stages. From adult literature it seems that an effective strategy for preventing relapse is to treat the acute episode with medication and then to augment with CBT for the continuation, or relapse prevention, phase. It is possible that therapy in continuation and maintenance phases provides a protective factor. Whether the protection is because of the general techniques of CBT or if there are more specific prevention techniques (eg, education about relapse prevention, wellness skills) that improve outcome is unclear.