***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: The efficacy of Structured Learning Therapy ( SLT ) in treating adolescent depression  was evaluated . SLT treatment focuses on developing social competencies , self-evaluation skills , and appropriate affective expression . Eighteen adolescents , aged 14 - 19 years , prescreened for depression were r and omly assigned to the SLT treatment or control group . All subjects participated in six biweekly 60-minute sessions . Pre- , post , and follow-up assessment s on depression , self-esteem , and personality measures were conducted . Results suggest that SLT reliably reduced depression in males ( p < .05 ) and maintained their improved level of functioning ( p < .02 ) . Female treatment subjects did not improve significantly . Results suggest differential effectiveness of treatment across gender Nine-month outcome data of a r and omized controlled out-patient trial of cognitive-behavioural treatment ( CBT ) for children and adolescents with depression are presented . CBT was compared with a non-focussed intervention ( NFI ) in 56 subjects . At 9 months after thr termination of the trial , 21 children ( 37.5 % ) fulfilled criteria for a psychiatric disorder ( DSM-III-R ) , out of whom 15 ( 26.8 % ) had a depressive illness . However , 25 subjects ( 45 % ) reported depressive symptoms of significant severity to suggest a depressive episode during the previous 9-month period . Both treatment groups maintained a significant improvement on all psychosocial measures since the post-treatment assessment . No significant treatment effect was established . Low self-esteem at the time of referral , predicted presence of psychiatric disorder , and child-reported scores of depressive symptoms and low self-esteem at follow-up . The research and clinical implication s for the treatment of depressive disorders in young life are discussed A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials BACKGROUND Previous studies in non clinical sample s have shown psychosocial treatments to be efficacious in the treatment of adolescent depression , but few psychotherapy treatment studies have been conducted in clinical ly referred , depressed adolescents . METHODS One hundred seven adolescent patients with DSM-III-R major depressive disorder ( MDD ) were r and omly assigned to 1 of 3 treatments : individual cognitive behavior therapy , systemic behavior family therapy ( SBFT ) , or individual nondirective supportive therapy ( NST ) . Treatments were 12 to 16 sessions provided in as many weeks . Intent-to-treat analyses were conducted using all follow-up data . RESULTS Of the 107 patients enrolled in the study , 78 ( 72.9 % ) completed the study , 4 ( 3.7 % ) never initiated treatment , 10 ( 9.3 % ) had exclusionary criteria that were undetected at entry , 8 ( 7.5 % ) dropped out , and 7 ( 6.5 % ) were removed for clinical reasons . Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST ( 17.1 % vs 42.4 % ; P = .02 ) , and result ed in a higher rate of remission ( 64.7 % , defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores < 9 ) than SBFT ( 37.9 % ; P = .03 ) or NST ( 39.4 % ; p = .04 ) . Cognitive behavior therapy result ed in more rapid relief in interviewer-rated ( vs both treatments , P = .03 ) and self-reported depression ( vs SBFT , P = .02 ) . All 3 treatments showed significant and similar reductions in suicidality and functional impairment . Parents ' views of the credibility of cognitive behavior therapy improved compared with parents ' views of both SBFT ( P = .01 ) and NST ( P = .05 ) . CONCLUSIONS Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical setting s , result ing in more rapid and complete treatment response Les auteurs ont trouve une efficacite semblable pour la therapie cognitivo-comportementale et pour la relaxation , dans le traitement de la depression chez Fifty-three child and adolescent psychiatric patients with depressive disorders were r and omly allocated to brief cognitive-behaviour therapy ( CBT ) or to a control treatment , relaxation training .  Forty-eight patients completed the treatment phase of the trial , which comprised 5 - 8 treatment sessions . Post-treatment assessment s showed a clear advantage of CBT over relaxation on measures of both depression and overall outcome . However , there were no significant differences between the treatments on comorbid anxiety and conduct symptoms . At follow-up , the differences between the groups were reduced , partly because of a high relapse rate in the DTP group and partly because subjects in the relaxation group continued to recover Elementary school children with mild-to-moderate depressive symptoms were r and omly assigned to a control group or an 8-session Primary and Secondary Control Enhancement Training program . The program focused on ( a ) primary control ( changing objective conditions to fit one 's wishes ; e.g. , through activity selection and goal attainment ) and ( b ) secondary control ( changing oneself to buffer the impact of objective conditions ; e.g. , altering depressogenic thinking , practicing mood-enhancing cognitions ) . At immediate posttreatment and 9-month follow-up , the treatment group showed greater reductions than the control group in depressive symptomatology on the Children 's Depression Inventory and the Revised Children 's Depression Rating Scale , and treated children , more than controls , shifted from above to within the normal range on both measures . Future research is needed to test treatment effects with severely depressed youths The potential effectiveness of imipramine hydrochloride ( up to 5 mg/kg/d ) was investigated in 53 prepubertal children suffering from major depressive disorder . Two complementary strategies were used simultaneously : a five-week , double-blind , placebo-controlled design ( N = 38 ) , and a plasma level/ clinical response study ( N = 30 ) . Fifteen of the 16 children r and omly assigned to active drug in the first study also participated in the second . Subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children and diagnosed according to unmodified Research Diagnostic Criteria .  Response rates in the double-blind study were similar in both groups ( imipramine , 56 % ; placebo , 68 % ) . In the plasma level study , total maintenance plasma level  ( imipramine plus desipramine ) was found to positively and linearly predict clinical response of the depressive syndrome ( P less than .003 ) . No evidence of a curvilinear relationship was found . Depressive hallucinations during the episode negatively predicted clinical response ( P less than .05 ) . Weight-corrected imipramine dosage did not predict either clinical response or plasma level in the individual subject . No predictors of response were found in the placebo group . These results suggest that the mean  imipramine dosage was too low , and that future double-blind , placebo-controlled studies of imipramine in prepubertal major depression should include plasma level titration to above 150 ng/mL and an initial placebo washout period This paper describes the development and preliminary efficacy of a program design ed to prevent depressive symptoms in at-risk 10 - 13 year-olds , and relates the findings to the current underst and ing of childhood depression . The treatment targets depressive symptoms and related difficulties such as conduct problems , low academic achievement , low social competence , and poor peer relations , by proactively teaching cognitive techniques .  Children were identified as ' at-risk ' based on depressive symptoms and their reports of parental conflict . Sixty-nine children participated in treatment groups  and were compared to 73 children in control groups .  Depressive symptoms were significantly reduced and classroom behavior was significantly improved in the treatment group as compared to controls at post-test . Six-month follow-up showed continued reduction in depressive symptoms , as well as significantly fewer externalizing conduct problems , as compared to controls . The reduction in symptoms was most pronounced in the children who were most at risk Conclusion We have illustrated how our “ small theory ” ( Lipsey , 1990 ) of bereavement guided the development and evaluation of a preventive intervention for bereaved children . Our small theory , based on prior empirical research , enabled us to identify family processes that appeared to mediate the effects of parental death on child mental health .  Our intervention was design ed to attempt to change these processes . The evaluation of our experimental trial of the intervention assessed changes on these processes as well as the more distal mental health outcomes . The experimental trial showed some-what encouraging results , in terms of the program 's ability to modify the warmth of the parent – child relationship and to decrease symptomatology in the adolescent children . We also obtained further empirical support for our underlying theoretical model . Finally , implication s for re design of the program were derived from assessing the adequacy of the program components to change each of the mediators in the theoretical model OBJECTIVE To explore the long-term impact of two forms of preventive intervention design ed to diminish risk to children in families in which one or both parents suffered from affective disorder . METHOD Fifty-four parents in 18 families were initially assessed and r and omly assigned to one of two interventions --a clinician-facilitated , manual-based , psychoeducational preventive intervention or a st and ardized lecture-group discussion in which similar educational information was presented . Assessment s included st and ard diagnostic interviews , child behavior scales , and semistructured interviews with parents about the effects of the intervention . Follow-up assessment s were conducted three times over the 3-year follow-up interval . RESULTS No harmful effects were reported for either intervention , and ratings of degree of upset about reported concerns declined across time for both conditions . Families receiving the clinician-facilitated intervention reported more behavior and attitude changes than did lecture-group families when assessed after intervention . The difference between the two groups was sustained at further follow-up assessment s. CONCLUSION Although both preventive interventions produced changes in behaviors and attitudes , parents in the clinician-facilitated intervention reported more benefit . These data support the hypothesis that linking cognitive information to the family 's life experience produces long-term changes A r and om assignment , double-blind , placebo-controlled study of nortriptyline in 50 prepubertal 6- to 12-year-olds with Research Diagnostic Criteria and DSM-III major depressive disorder was performed . The protocol included a 2-week placebo wash-out phase and an 8-week double-blind , placebo-controlled phase with weekly plasma level monitoring . Active subjects had their plasma level pharmacokinetically placed at 80 + /- 20 ng/ml by using previously developed tables to determine the starting dose from a plasma level 24 hours after a single dose administered at baseline . The mean plasma level was 89.9 ng/ml . The study population was severely depressed , had a chronic , unremitting course of long duration before the study , had a high percentage of family histories with affective disorder , alcoholism and suicidality , and had a high rate of comorbidity . None of the subjects had ever received tricyclic antidepressants before this study . There was a poor rate of response in both treatment groups ( 30.8 % active , 16.7 % placebo ) . Active subjects did not evidence the anticholinergic side effects reported in adult sample s. The implication s of these findings for future pharmacotherapy studies of depressed children are discussed Forty patients aged 13 to 18 years participated in a placebo-controlled double-blind study of fluoxetine .  Fifteen subjects in each group completed the eight week study . Approximately two-thirds of the patients showed marked or moderate clinical global improvement with both fluoxetine and placebo . Fluoxetine was superior to placebo on all clinical measures except for sleep disorder , but the differences were not statistically significant . Thirty-two of the patients and their parents were interviewed after a mean follow-up interval of 24 months ( range : 8 - 46 months ) . Mean age at follow-up was 18 years ( range : 15 - 22 years ) . Both groups had shown further improvement at follow-up but there were no significant group differences . Independent of the study , 19 patients ( 59 % ) had received intervening treatment following study termination and nine patients ( 28 % ) were still in treatment .  Adolescent depression  appears to respond to treatment but both mood disturbance and psychosocial adaptation problems persist , requiring active follow-through We performed a r and om assignment , double-blind , placebo-controlled study of nortriptyline ( NT ) in postpubertal 12- to 17-year-olds with Research Diagnostic Criteria ( RDC ) and DSM-III major depressive disorder . The protocol included a 2-week placebo washout phase and an 8-week double-blind , placebo-controlled phase with weekly plasma level monitoring . Active subjects had their plasma level placed at 80 + /- 20 ng/ml by using previously developed tables to determine the starting dose from a plasma level drawn 24 hours after a single 
    Output:
    
CONCLUSIONS Cognitive behaviour therapy may be of benefit for depressive disorder of moderate severity in children and adolescents .
It can not , however , yet be recommended for severe depression .