SECTION THREE Treating Major Depression in Diverse Populations

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Treatment of Adolescent Depression with Interpersonal Psychotherapy

LAURA MUFSON, LAURIE REIDER LEWIS, MEREDITH GUNLICKS-STOESSEL, AND JAMI F. YOUNG

We adapted IPT for depressed adolescents (IPT-A) hoping to build upon the research demonstrating its efficacy with depressed adults. The interpersonal model seemed appropriate for adolescents given their focus on interpersonal relationships and the significant developmental changes that occur in these relationships, such as separation and individuation from parents and increased focus on peer and romantic relationships. IPT-A strategies help adolescents to bolster self-confidence and make steps toward increasing independence while helping them to understand how they still depend on others and how they can negotiate their relationships more successfully (Mufson, Dorta, Moreau & Weissman, 2004).

The use of IPT-A is supported by research on the qualities of relationships and types of stressors common in adolescence. Common interpersonal stressors associated with depression in adolescents include problems with peers (Brunstein-Klomek, Marrocco, Kleinman, et al., 2007) and conflictual and unsupportive relationships with parents (Sheeber et al., 2007). Depressed adolescents display more negative affect in interactions with parents than healthy adolescents (Sanders, Dadds, Johnston, & Cash, 1992; Sheeber, Allen, Davis, & Sorensen, 2000). The negative affect in turn interferes with adolescents’ ability to communicate or solve problems effectively, increasing their risk for more interpersonal difficulties and subsequent depression (Gotlib & Hammen, 1992). As IPT-A targets these communication and problem-solving impairments in both family and peer relationships, we believed this treatment would benefit depressed adolescents.

IPT-A is designed for adolescents with mild to moderate depressive severity who meet criteria for a DSM-IV depression diagnosis and can be treated as outpatients. Adolescents suffering from comorbidities including anxiety disorders, attention- deficit/hyperactivity disorder, and oppositional defiant disorder have been successfully treated with IPT-A, although IPT-A is most effective when depression is the primary diagnosis and comorbidity is limited. IPT-A is not indicated for adolescents whose IQ lies in the mentally retarded range, are actively suicidal, homicidal, or abusing substances, or suffer from psychotic symptoms or bipolar disorder.

 
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