Psychoeducational Psychotherapy and Omega-3 Supplementation Improve Co-Occurring Behavioral Problems in Youth with Depression: Results from a Pilot RCT
- 515 Downloads
This pilot randomized controlled trial (RCT) investigated benefits of omega-3 fatty acid supplementation and Individual-Family Psychoeducational Psychotherapy (PEP; a family-focused, cognitive-behavioral therapy) for behavior problems among youth with depression. Participants aged 7–14 with DSM-IV-TR depressive disorders (N = 72; 56.9 % male) were randomized to 1 of 4 treatment conditions: PEP + omega-3, PEP monotherapy (with pill placebo), omega-3 monotherapy, or placebo (without active intervention). At screen, baseline, and 2, 4, 6, 9, and 12 weeks post-baseline, parents completed the SNAP-IV, which assesses attention-deficit/hyperactivity disorder symptoms, oppositional defiant disorder symptoms, and overall behavior problems. At screen, baseline (randomization), 6 and 12 weeks, parents completed the Eyberg Child Behavior Inventory (ECBI), which includes Intensity and Problem scales for child behavior problems. Youth who had a completed SNAP-IV or ECBI for at least two assessments during treatment (n = 48 and 38, respectively) were included in analyses of the respective outcome. ClinicalTrials.gov.:NCT01341925. Linear mixed effects models indicated a significant effect of combined PEP + omega-3 on SNAP-IV Total (p = 0.022, d = 0.80) and Hyperactivity/Impulsivity trajectories (p = 0.008, d = 0.80), such that youth in the combined group saw greater behavioral improvement than those receiving only placebo. Similarly, youth in combined treatment had more favorable ECBI Intensity trajectories than youth who received no active treatment (p = 0.012, d = 1.07). Results from this pilot RCT suggest that combined PEP + omega-3 is a promising treatment for co-occurring behavior symptoms in youth with depression.
KeywordsRandomized controlled trial Depression Children Adolescents Psychotherapy Omega-3 supplementation
This research was supported by National Institute of Mental Health award# R34 MH85875; the content is solely the responsibility of the authors and does not necessarily represent the official views of NIH. The authors would like to thank staff who collected data and provided therapy, families who participated, and OmegaBrite, who provided study capsules.
Compliance with Ethical Standards
Dr. Young has received research funding from Psychnostics, LLC. Dr. Arnold has received research funding from Curemark, Forest, Lilly, Neuropharm, Novartis, Noven, Shire, Supernus, and YoungLiving (as well as NIH and Autism Speaks) and has consulted with or been on advisory boards for Arbor, Gowlings, Ironshore, Neuropharm, Novartis, Noven, Organon, Otsuka, Pfizer, Roche, Seaside Therapeutics, Sigma Tau, Shire, Tris Pharma, and Waypoint. Dr. Fristad receives royalties from Guilford Press, American Psychiatric Press and CFPSI for treatment manuals, workbooks and a diagnostic instrument reported on in this study and honoraria from Physician’s Post-Graduate Press and the American Occupational Therapy Association.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent/assent was obtained from all individual participants included in the study.
- American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed., text revision ed.). Washington, DC: American Psychiatric Association.Google Scholar
- Axelson, D., Birmaher, B. J., Brent, D., Wassick, S., Hoover, C., Bridge, J., & Ryan, N. (2003). A preliminary study of the kiddie schedule for affective disorders and schizophrenia for school-age children mania rating scale for children and adolescents. Journal of Child and Adolescent Psychopharmacology, 13, 463–470. doi: 10.1089/104454603322724850.CrossRefPubMedGoogle Scholar
- Birmaher, B., Brent, D., & the AACAP Work Group on Quality Issues (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1503–1526. doi: 10.1097/chi.0b013e318145ae1c.CrossRefPubMedGoogle Scholar
- Bloch, M. H., & Qawasmi, A. (2011). Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 991–1000. doi: 10.1016/j.jaac.2011.06.008.CrossRefPubMedPubMedCentralGoogle Scholar
- Bos, D. J., Oranje, B., Veerhoek, E. S., Van Diepen, R. M., Weusten, J. M., Demmelmair, H., et al. (2015). Reduced symptoms of inattention after dietary omega-3 fatty acid supplementation in boys with and without attention deficit/hyperactivity disorder. Neuropsychopharmacology, 40, 2298–2306. doi: 10.1038/npp.2015.73.CrossRefPubMedPubMedCentralGoogle Scholar
- Boylan, K., MacPherson, H. A., & Fristad, M. A. (2013). Examination of disruptive behavior outcomes and moderation in a randomized psychotherapy trial for mood disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 52, –708. doi: 10.1016/j.jaac.2013.04.014.
- Bridge, J. A., Iyengar, S., Salary, C. B., Barbe, R. P., Birmaher, B., Pincus, H. A., et al. (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA, 297, 1683–1696. doi: 10.1001/jama.297.15.1683.CrossRefPubMedGoogle Scholar
- Bussing, R., Fernandez, M., Harwood, M., Hou, W., Garvan, C. W., Eyberg, S. M., & Swanson, J. M. (2008). Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms psychometric properties and normative ratings from a school district sample. Assessment, 15, 317–328. doi: 10.1177/1073191107313888.CrossRefPubMedPubMedCentralGoogle Scholar
- Chambers, W. J., Puig-Antich, J., Hirsch, M., Paez, P., Ambrosini, P. J., Tabrizi, M. A., & Davies, M. (1985). The assessment of affective disorders in children and adolescents by semistructured interview: test-retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version. Archives of General Psychiatry, 42, 696–702. doi: 10.1001/archpsyc.1985.01790300064008.CrossRefPubMedGoogle Scholar
- Clarke, G. N., Rohde, P., Lewinsohn, P. M., Hops, H., & Seeley, J. R. (1999). Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 272–279. doi: 10.1097/00004583-199903000-00014.CrossRefPubMedGoogle Scholar
- Clayton, E. H., Hanstock, T. L., Hirneth, S. J., Kable, C. J., Garg, M. L., & Hazell, P. L. (2009). Reduced mania and depression in juvenile bipolar disorder associated with long-chain omega-3 polyunsaturated fatty acid supplementation. European Journal of Clinical Nutrition, 63, 1037–1040. doi: 10.1038/ejcn.2008.81.CrossRefPubMedGoogle Scholar
- Diamond, G. S., Reis, B. F., Diamond, G. M., Siqueland, L., & Isaacs, L. (2002). Attachment-based family therapy for depressed adolescents: a treatment development study. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1190–1196. doi: 10.1097/00004583-200210000-00008.CrossRefPubMedGoogle Scholar
- Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory & sutter-eyberg student behavior inventory-revised: professional manual. Odessa: Psychological Assessment Resources.Google Scholar
- Fristad, M. A., Goldberg-Arnold, J. S., & Leffler, J. M. (2011). Psychotherapy for children with bipolar and depressive disorders. New York: Guilford Press.Google Scholar
- Fristad, M. A., Young, A. S., Vesco, A. T., Nader, E. S., Healy, K. Z., Gardner, W., et al. (2015). A randomized controlled trial of individual family psychoeducational psychotherapy & omega-3 fatty acids in youth with subsyndromal bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 25, 764–774. doi: 10.1089/cap.2015.0132.CrossRefPubMedPubMedCentralGoogle Scholar
- Fristad, M. A., Vesco, A. T., Young, A. S., Healy, K. Z., Nader, E. S., Gardner, W.,… Arnold, L. E. (2016). Pilot RCT of omega-3 and individual-family psychoeducational psychotherapy for children and adolescents with depression. Journal of Clinical Child and Adolescent Psychology (in press).Google Scholar
- Jacobs, R. H., Becker-Weidman, E. G., Reinecke, M. A., Jordan, N., Silva, S. G., Rohde, P., & March, J. S. (2010). Treating depression and oppositional behavior in adolescents. Journal of Clinical Child and Adolescent Psychology, 39, 559–567. doi: 10.1080/15374416.2010.486318.CrossRefPubMedPubMedCentralGoogle Scholar
- Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988. doi: 10.1097/00004583-199707000-00021.CrossRefPubMedGoogle Scholar
- Knapp, M., McCrone, P., Fombonne, E., Beecham, J., & Wostear, G. (2002). The Maudsley long-term follow-up of child and adolescent depression 3. Impact of comorbid conduct disorder on service use and costs in adulthood. British Journal of Psychiatry, 180, 19–23. doi: 10.1192/bjp.180.1.19.CrossRefPubMedGoogle Scholar
- Pliszka, S., & AACAP Work Group on Quality Issues (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 894–921. doi: 10.1097/chi.0b013e318054e724.CrossRefPubMedGoogle Scholar
- Raine, A., Portnoy, J., Liu, J., Mahoomed, T., & Hibbeln, J. R. (2015). Reduction in behavior problems with omega-3 supplementation in children aged 8-16 years: a randomized, double-blind, placebo-controlled, stratified, parallel-group trial. Journal of Child Psychology and Psychiatry, 56, 509–520. doi: 10.1111/jcpp.12314.CrossRefPubMedGoogle Scholar
- Rohde, P., Clarke, G. N., Lewinsohn, P. M., Seeley, J. R., & Kaufman, N. K. (2001). Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 795–802. doi: 10.1097/00004583-200107000-00014.CrossRefPubMedGoogle Scholar
- Smeets, K. C., Leeijen, A. A., van der Molen, M. J., Scheepers, F. E., Buitelaar, J. K., & Rommelse, N. N. (2015). Treatment moderators of cognitive behavior therapy to reduce aggressive behavior: a meta-analysis. European Child & Adolescent Psychiatry, 24, 255–264. doi: 10.1007/s00787-014-0592-1.CrossRefGoogle Scholar
- Sonuga-Barke, E. J., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M., et al. (2013). Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170, 275–289. doi: 10.1176/appi.ajp.2012.12070991.CrossRefPubMedGoogle Scholar
- Steiner, H., Remsing, L., & AACAP Work Group on Quality Issues (2007). Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 126–141. doi: 10.1097/01.chi.0000246060.62706.af.CrossRefPubMedGoogle Scholar
- Swanson, J. M. (1992). School-based assessments and interventions for ADD students. Irvine: KC Publishing.Google Scholar
- Swanson, J. M., Kraemer, H. C., Hinshaw, S. P., Arnold, L. E., Conners, C. K., Abikoff, H. B., et al. (2001). Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 168–179. doi: 10.1097/00004583-200102000-00011.CrossRefPubMedGoogle Scholar
- Tammam, J. D., Steinsaltz, D., Bester, D. W., Semb-Andenaes, T., & Stein, J. F. (2016). A randomised double-blind placebo-controlled trial investigating the behavioural effects of vitamin, mineral and n-3 fatty acid supplementation in typically developing adolescent schoolchildren. British Journal of Nutrition, 115, 361–373. doi: 10.1017/S0007114515004390.CrossRefPubMedGoogle Scholar
- U.S. Food and Drug Administration (2004). FDA launches a multi-pronged strategy to strengthen safeguards for children treated with antidepressant medications. Silver Spring: U.S. Food and Drug Administration.Google Scholar