Interpersonal Psychotherapy for Depressed Adolescents (IPT-A)

Article excerpt

Abstract: Objectives: Recently the Food and Drug Administration (FDA) published a black box warning on the use of serotonin receptor reuptake inhibitors for adolescent depression. This situation makes the non-pharmacological therapeutic alternatives more relevant than ever before. The aim of this review is to introduce the theoretical formulation, practical application and efficacy studies of Interpersonal Psychotherapy for depressed adolescents (IPT-A). Method: A review is offered of published papers in peer-reviewed journals, books and edited chapters using Medline and Psychlnfo publications between 1966 and February 2005. Results: IPT-A is an evidence-based psychotherapy for depressed adolescents in both hospital-based and community outpatient settings. Conclusion: IPT-A is a brief and efficient therapy for adolescent depression. Training programs for child psychologists and psychiatrists are recommended.

Introduction

The prevalence of adolescent depression in the general population is substantial, ranging from 3% to 9% (1). Major depression has been associated with impairment in psychosocial functioning at school, with friends and with family (2-4). Depression has been identified also as a leading risk factor for suicidal ideation and attempts (5) and completed suicide (6). Studies following depressed adolescents find high rates of recurrence into adulthood (7, 8).

There are many types of treatment for depressed adolescents including psychodynamic/psychoanalytic psychotherapy, cognitive behavioral therapy, family therapy, group therapy and pharmacotherapy. Many of these treatments are widely used in clinical practice despite the fact that they lack sufficient evidence for their efficacy with adolescents. Recently the Food and Drug Administration (FDA) published a black box warning on the use of serotonin receptor reuptake inhibitors (SSRI) for adolescent depression. This situation makes the non-pharmacological therapeutic alternatives more relevant than ever before.

Evidence based therapies include specific adaptations of Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) (9). Research has shown CBT to be superior to a variety of therapies, although a substantial number of adolescents still do not benefit from this form of intervention and the reoccurrence of depression after an acute treatment is high (9). Interpersonal psychotherapy for adolescents (IPT-A) is the most recent psychotherapeutic intervention to be developed and has been found to be effective in several clinical trials of acute treatment (10-12).

Interpersonal Psychotherapy (IPT)

Interpersonal therapy (IPT) (13) was initially developed as a time-limited, focused treatment of depressed non-bipolar adult outpatients. The main goals of IPT are to decrease depressive symptomatology and to improve interpersonal functioning. IPT assumes that the development of clinical depression occurs in a social and interpersonal context and that the onset, response to treatment and outcomes are influenced by the interpersonal relations between the depressed patient and significant others (14-16).

Clinical depression in the IPT framework is conceptualized as having three components: symptom formation, social functioning and personality. IPT intervenes in the first two processes but it does not purport to have an impact on the enduring aspects of personality (13, 17).

The therapeutic model conceptualizes four specific interpersonal problems: interpersonal disputes, role transitions, grief and interpersonal deficits. The therapy usually focuses on one of these problem areas.

1. Interpersonal Disputes tend to occur in marital, family, social or work settings. They can be conceptualized as a situation in which the patient and other parties have diverging expectations of a situation and this conflict is severe enough to lead to significant distress. In these circumstances, IPT would aim to define how intractable the dispute was and identify sources of misunderstanding via faulty communication and invalid or unreasonable expectations. …