***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Open-label trials with the selective serotonin reuptake inhibitor citalopram suggest that this agent is effective and safe for the treatment of depressive symptoms in children and adolescents . The current study investigated the efficacy and safety of citalopram compared with placebo in the treatment of pediatric patients with major depression . METHOD An 8-week , r and omized , double-blind , placebo-controlled study compared the safety and efficacy of citalopram with placebo in the treatment of children ( ages 7 - 11 ) and adolescents ( ages 12 - 17 ) with major depressive disorder . Diagnosis was established with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version . Patients ( N=174 ) were treated initially with placebo or 20 mg/day of citalopram , with an option to increase the dose to 40 mg/day at week 4 if clinical ly indicated . The primary outcome measure was score on the Children 's Depression Rating Scale-Revised ; the response criterion was defined as a score of < or = 28 . RESULTS The overall mean citalopram dose was approximately 24 mg/day . Mean Children 's Depression Rating Scale-Revised scores decreased significantly more from baseline in the citalopram treatment group than in the placebo treatment group , beginning at week 1 and continuing at every observation point to the end of the study ( effect size=2.9 ) . The difference in response rate at week 8 between placebo ( 24 % ) and citalopram ( 36 % ) also was statistically significant . Citalopram treatment was well tolerated . Rates of discontinuation due to adverse events were comparable in the placebo and citalopram groups ( 5.9 % versus 5.6 % , respectively ) . Rhinitis , nausea , and abdominal pain were the only adverse events to occur with a frequency exceeding 10 % in either treatment group . CONCLUSIONS In this population of children and adolescents , treatment with citalopram reduced depressive symptoms to a significantly greater extent than placebo treatment and was well tolerated OBJECTIVE To compare paroxetine with placebo and imipramine with placebo for the treatment of adolescent depression . METHOD After a 7- to 14-day screening period , 275 adolescents with major depression began 8 weeks of double-blind paroxetine ( 20 - 40 mg ) , imipramine ( gradual upward titration to 200 - 300 mg ) , or placebo . The two primary outcome measures were endpoint response ( Hamilton Rating Scale for Depression [ HAM-D ] score < or = 8 or > or = 50 % reduction in baseline HAM-D ) and change from baseline HAM-D score . Other depression-related variables were ( 1 ) HAM-D depressed mood item ; ( 2 ) depression item of the Schedule for Affective Disorders and Schizophrenia for Adolescents-Lifetime version ( K-SADS-L ) ; ( 3 ) Clinical Global Impression ( CGI ) improvement scores of 1 or 2 ; ( 4 ) nine-item depression subscale of K-SADS-L ; and ( 5 ) mean CGI improvement scores . RESULTS Paroxetine demonstrated significantly greater improvement compared with placebo in HAM-D total score < or = 8 , HAM-D depressed mood item , K-SADS-L depressed mood item , and CGI score of 1 or 2 . The response to imipramine was not significantly different from placebo for any measure . Neither paroxetine nor imipramine differed significantly from placebo on parent- or self-rating measures . Withdrawal rates for adverse effects were 9.7 % and 6.9 % for paroxetine and placebo , respectively . Of 31.5 % of subjects stopping imipramine therapy because of adverse effects , nearly one third did so because of adverse cardiovascular effects . CONCLUSIONS Paroxetine is generally well tolerated and effective for major depression in adolescents OBJECTIVE To design a treatment manual and adherence measure for attachment-based family therapy ( ABFT ) for adolescent depression and to collect pilot data on the treatment 's efficacy . METHOD Over a period of 2 years , 32 adolescents meeting criteria for major depressive disorder ( MDD ) were r and omly assigned to 12 weeks of ABFT or a 6-week , minimal-contact , waitlist control group . The sample was 78 % female and 69 % African American ; 69 % were from low-income , inner-city communities . RESULTS At post-treatment , 81 % of the patients treated with ABFT no longer met criteria for MDD , in contrast with 47 % of patients in the waitlist group . Mixed factorial analyses of variance revealed that , compared with the waitlist group , patients treated with ABFT showed a significantly greater reduction in both depressive and anxiety symptoms and family conflict . Of the 15 treated cases assessed at the follow-up , 13 patients ( 87 % ) continued to not meet criteria for MDD 6 months after treatment ended . CONCLUSIONS ABFT appears to be a promising treatment and worthy of further development OBJECTIVE Escitalopram is a selective serotonin reuptake inhibitor antidepressant indicated for use in adults . This trial examined the efficacy and safety of escitalopram in pediatric depression . METHOD Patients ( 6 - 17 years old ) with major depressive disorder were r and omized to receive 8 weeks of double-blind flexibly dosed treatment with  escitalopram  ( 10 - 20 mg/day ; n = 131 ) or placebo  ( n = 133 ) . R and omization was not stratified by age . The primary efficacy measure was the mean change from baseline to endpoint in Children 's Depression Rating Scale-Revised ( CDRS-R ) scores , using the last observation carried forward approach . RESULTS A total of 82 % of patients completed treatment .  Escitalopram did not significantly improve CDRS-R scores compared to placebo at endpoint ( least squares mean difference = -1.7 , p = .31 ; last observation carried forward ) . In a post hoc analysis of adolescent ( ages 12 - 17 years ) completers , escitalopram significantly improved CDRS-R scores compared with placebo ( least squares mean difference = -4.6 , p = .047 ) . Headache and abdominal pain were the only adverse events in > 10 % of patients in the escitalopram group . Discontinuation rates caused by adverse events were 1.5 % for both groups . Potential suicide-related events were observed in one escitalopram- and two placebo-treated patients . There were no completed suicides . CONCLUSIONS Although there were no significant differences between escitalopram and placebo in the total population , the data suggest that escitalopram may have beneficial effects in adolescent patients .  Escitalopram appeared to be well tolerated OBJECTIVE To assess the efficacy and tolerability of paroxetine in pediatric major depressive disorder . METHOD Subjects 7 to 17 years old with major depressive disorder received paroxetine ( 10 - 50 mg/day ) or placebo for 8 weeks from 2000 to 2001 . The primary efficacy measure was change from baseline in the Children 's Depression Rating Scale-Revised total score at week 8 last observation carried forward ) . Safety was primarily assessed by spontaneous reporting of adverse events . RESULTS A total of 206 patients ( intent to treat ) were r and omized to paroxetine ( n = 104 ) or placebo ( n = 102 ) . Week 8 Children 's Depression Rating Scale-Revised total score adjusted mean changes from baseline for patients receiving paroxetine and placebo were -22.58 ( SE 1.47 ) and -23.38 points ( SE 1.60 ) , respectively ( 0.80 , 95 % confidence interval -3.09 to 4.69 , p = 0.684 ) . Increased cough ( 5.9 % versus 2.9 % ) , dyspepsia ( 5.9 % versus 2.9 % ) , vomiting ( 5.9 % versus 2.0 % ) , and dizziness ( 5.0 % versus 1.0 % ) occurred in > or=5 % of the paroxetine group and at least twice that of the placebo group . Six of 104 ( 5.8 % ) paroxetine patients reported serious adverse events compared to 1 placebo patient ( 1.0 % ) . The incidence of adverse events of suicidal behavior and /or ideation while taking study medication ( excluding taper ) was 1.92 % ( 2/104 ) for paroxetine versus 0.98 % ( 1/102 ) for placebo . CONCLUSIONS Paroxetine was not shown to be more efficacious than placebo for treating pediatric major depressive disorder CONTEXT Initial treatment of major depressive disorder in adolescents may include cognitive-behavioral therapy ( CBT ) or a selective serotonin reuptake inhibitor ( SSRI ) . However , little is known about their relative or combined effectiveness . OBJECTIVE To evaluate the effectiveness of 4 treatments among adolescents with major depressive disorder . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of a volunteer sample of 439 patients between the ages of 12 to 17 years with a primary Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , diagnosis of major depressive disorder . The trial was conducted at 13 US academic and community clinics between spring 2000 and summer 2003 . INTERVENTIONS Twelve weeks of ( 1 ) fluoxetine alone ( 10 to 40 mg/d ) , ( 2 ) CBT alone , ( 3 ) CBT with fluoxetine ( 10 to 40 mg/d ) , or ( 4 ) placebo ( equivalent to 10 to 40 mg/d ) . Placebo and fluoxetine alone were administered double-blind ; CBT alone and CBT with fluoxetine were administered unblinded . MAIN OUTCOME MEASURES Children 's Depression Rating Scale-Revised total score and , for responder analysis , a ( dichotomized ) Clinical Global Impressions improvement score . RESULTS Compared with placebo , the combination of fluoxetine with CBT was statistically significant ( P = .001 ) on the Children 's Depression Rating Scale-Revised . Compared with fluoxetine alone ( P = .02 ) and CBT alone ( P = .01 ) , treatment of fluoxetine with CBT was superior . Fluoxetine alone is a superior treatment to CBT alone ( P = .01 ) . Rates of response for fluoxetine with CBT were 71.0 % ( 95 % confidence interval [ CI ] , 62%-80 % ) ; fluoxetine alone , 60.6 % ( 95 % CI , 51%-70 % ) ; CBT alone , 43.2 % ( 95 % CI , 34%-52 % ) ; and placebo , 34.8 % ( 95 % CI , 26%-44 % ) . On the Clinical Global Impressions improvement responder analysis , the 2 fluoxetine-containing conditions were statistically superior to CBT and to placebo . Clinical ly significant suicidal thinking , which was present in 29 % of the sample at baseline , improved significantly in all 4 treatment groups . Fluoxetine with CBT showed the greatest reduction ( P = .02 ) . Seven ( 1.6 % ) of 439 patients  attempted suicide ; there were no completed suicides . CONCLUSION The combination of fluoxetine with CBT offered the most favorable tradeoff between benefit and risk for adolescents with major depressive disorder CONTEXT The efficacy , safety , and tolerability of selective serotonin reuptake inhibitors ( SSRIs ) in the treatment of adults with major depressive disorder ( MDD ) are well established . Comparatively few data are available on the effects of SSRIs in depressed children and adolescents . OBJECTIVE To evaluate the efficacy and safety of sertraline compared with placebo in treatment of pediatric patients with MDD . DESIGN AND SETTING Two multicenter r and omized , double-blind , placebo-controlled trials were conducted at 53 hospital , general practice , and academic centers in the United States , India , Canada , Costa Rica , and Mexico between December 1999 and May 2001 and were pooled a priori . PARTICIPANTS Three hundred seventy-six children and adolescents aged 6 to 17 years with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition-defined MDD of at least moderate severity . INTERVENTION Patients were r and omly assigned to receive a flexible dosage ( 50 - 200 mg/d ) of sertraline ( n = 189 ) or matching placebo tablets ( n = 187 ) for 10 weeks . MAIN OUTCOME MEASURES Change from baseline in the Children 's Depression Rating Scale-Revised ( CDRS-R ) Best Description of Child total score and reported adverse events . RESULTS Sertraline-treated patients experienced statistically significantly greater improvement than placebo patients on the CDRS-R total score ( mean change at week 10 , -30.24 vs -25.83 , respectively ; P = .001 ; overall mean change , -22.84 vs -20.19 , respectively ; P = .007 ) . Based on a 40 % decrease in the adjusted CDRS-R total score at 
    Output:
    
We found no data describing health outcomes among screened and unscreened population s. Although the literature on diagnostic screening test accuracy is small and method ologically limited , it indicates that several screening instruments have performed fairly well among adolescents .
Available data indicate that selective serotonin reuptake inhibitors , psychotherapy , and combined treatment are effective in increasing response rates and reducing depressive symptoms .
Not all specific selective serotonin reuptake inhibitors , however , seem to be efficacious .
Selective serotonin reuptake inhibitor treatment was associated with a small absolute increase in risk of suicidality ( ie , suicidal ideation , preparatory acts , or attempts ) .
Limited available data suggest that primary care – feasible screening tools may accurately identify depressed adolescents and treatment can improve depression outcomes .
Treating depressed youth with selective serotonin reuptake inhibitors may be associated with a small increased risk of suicidality and should only be considered if judicious clinical monitoring is possible