***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: BACKGROUND There is great heterogeneity of clinical presentation and outcome in paediatric depression . AIMS To identify which clinical and environmental risk factors at baseline and during treatment predicted major depression at 28-week follow-up in a sample of adolescents with depression . METHOD One hundred and ninety-two British adolescents with unipolar major depression were enrolled in a r and omised controlled trial ( the Adolescent Depression Antidepressants and Psychotherapy Trial , ADAPT ) . Participants were treated for 28 weeks with routine psychosocial care and selective serotonin reuptake inhibitors ( SSRIs ) , with half also receiving cognitive-behavioural therapy ( CBT ) . Full clinical and demographic assessment was carried out at baseline and 28 weeks . RESULTS Depression at 28 weeks was predicted by the additive effects of severity , obsessive-compulsive disorder and suicidal ideation at entry together with presence of at least one disappointing life event over the follow-up period . CONCLUSIONS Clinicians should assess for severity , suicidality and comorbid obsessive-compulsive disorder at presentation and should monitor closely for subsequent life events during treatment 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 examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide . METHOD Adolescents ( N = 124 ) , ages 12 to 18 years , with a 90-day history of suicide attempt , a current diagnosis of depressive disorder ( 96.0 % had major depressive disorder ) , and a Children 's Depression Rating Scale-Revised ( CDRS-R ) score of 36 or higher , entered a 6-month treatment with antidepressant medication , cognitive-behavioral therapy focused on suicide prevention , or their combination ( Comb ) , at five academic sites . Treatment assignment could be either r and om or chosen by study participants . Intent-to-treat , mixed effects regression models of depression and other relevant ratings were estimated . Improvement and remission rates were computed with the last observation carried forward . RESULTS Most patients ( n = 104 or 84 % ) chose treatment assignment , and overall , three fourths ( n = 93 ) received Comb . In Comb , CDRS-R declined from a baseline adjusted mean of 49.6 ( SD 12.3 ) to 38.3 ( 8.0 ) at week 12 and to 27.0 ( 10.1 ) at week 24 ( p < .0001 ) , with a Clinical Global Impression -defined improvement rate of 58.0 % at week 12 and 72.2 % at week 24 and a remission ( CDRS-R ≤ 28 ) rate of 32.5 % at week 12 and 50.0 % at week 24 . The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline ( r = 0.43 , p < .0001 ) and declined in parallel . CONCLUSIONS When vigorously treated with a combination of medication and psychotherapy , adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression BACKGROUND Psychiatric clinics have high non-attendance rates and failure to attend may be a sign of deteriorating mental health . AIMS To investigate why psychiatric out- patients fail to attend , and the outcome of attenders and non-attenders . METHOD Prospect i ve cohort study of r and omly selected attenders and non-attenders at general adult psychiatric out-patient clinics . Subjects were interviewed at recruitment and severity of mental disorder and degree of social adjustment were measured . Six and 12 months later their engagement with the clinic and any psychiatric admissions were ascertained . RESULTS Of the 365 patients included in the study , 30 were untraceable and 224 consented to participate . Follow-up patients were more psychiatrically unwell than new patients . For follow-up patients , non-attenders had lower social functioning and more severe mental disorder than those who attended . At 12-month follow-up patients who missed their appointment were more likely to have been admitted than those who attended . CONCLUSIONS Those who miss psychiatric follow-up out-patient appointments are more unwell and more poorly socially functioning than those who attend . They have a greater chance of drop-out from clinic contact and subsequent admission Our recent 8-week , r and omized , placebo-controlled trial of fluoxetine in adolescents ( ages 12 - 17 years ) with comorbid depression and substance use disorder ( SUD ) did not detect a significant antidepressant treatment effect . The purpose of this secondary analysis was to explore moderators of the effect of fluoxetine in this sample . Static moderators measured at baseline were depression chronicity and hopelessness severity ; time-varying moderators measured at baseline and weekly during the 8-week trial period were alcohol and marijuana use severity . Treatment effects on depression outcomes were examined among moderating subgroups in r and om effects regression models . Subjects assigned to fluoxetine treatment with chronic depression at baseline ( p = .04 ) or no more than moderate alcohol use during the trial ( p = .04 ) showed significantly greater decline in depression symptoms in comparison to placebo-assigned subgroups . The current analysis suggests that youth with chronic depression and no more than moderate alcohol consumption are likely to respond better to treatment with fluoxetine compared with placebo than youth with transient depression and heavy alcohol use OBJECTIVE A r and omized , double-blind , placebo-controlled flexible-dose , parallel group trial was conducted at 26 clinical investigational sites in the United States to examine the safety and efficacy of the selegiline transdermal system ( STS ) ( EMSAM ® ) in adolescents ( ages 12 - 17 years ) meeting American Psychiatric Association , Diagnostic and Statistical Manual of Mental Disorders , 4th ed . ( DSM-IV ) criteria for moderate to severe major depressive disorder ( MDD ) without psychotic features . METHODS Adolescents ( n=308 ) with moderate to severe MDD were r and omized to either STS ( n=152 ) or placebo ( n=156 ) . Two hundred and fifteen ( 69.8 % ) subjects completed the study and 17 ( 5.5 % ) reported discontinuation because of adverse events ( AEs ) . The primary efficacy outcome measure was the mean change from baseline to end of study ( week 12 last observation carried forward [ LOCF ] ) in the Children 's Depression Rating Scale-Revised ( CDRS-R ) total score . Secondary outcome measures included end-point Clinical Global Impressions - Severity ( CGI-S ) and Clinical Global Impressions - Improvement ( CGI-I ) . RESULTS Patients on STS or placebo had a significant decline from baseline ( p<0.001 ) on their CDRS-R total score with mean reductions±SD as follows : STS 21.4±16.6 ; placebo 21.5±16.5 . Both groups had similar response rates ( 58.6 % vs. 59.3 % ) defined as CGI-I of 1 or 2 at study end . However , these between-group efficacy findings were without statistical significance . The overall incidence of reported AEs was 62.5 % for STS-treated patients and 57.7 % for placebo-treated patients . Most commonly reported AEs in STS or placebo groups were application site reactions ( STS=24.3 % ; placebo=21.8 % ) , headache ( STS=17.1 % ; placebo=16.7 % ) , and nausea ( STS=7.2 % ; placebo=7.7 % ) . Treatment groups did not differ on any laboratory parameters , vital signs , or electrocardiogram ( ECG ) findings . No suspected hypertensive crises were reported in the trial . CONCLUSIONS These data demonstrated that the STS was safe and well tolerated in this adolescent sample . However , both STS-treated and placebo-treated subjects demonstrated a decline from baseline in depressive symptoms ( CDRS-R total score ) over the length of the study , without statistical superiority by either group OBJECTIVE To determine amitriptyline 's ( AMI )  efficacy in the acute treatment of adolescent major depressive disorder ( MDD ) . METHOD Subjects aged 12 through 17 years meeting Research Diagnostic Criteria for MDD , diagnosed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children ( K-SADS ) , participated in a 2-week placebo-washout followed by an 8-week , r and omized , double-blind , parallel- design , placebo-controlled trial of AMI , 5 mg/kg per day . The K-SADS nine-item scale , the Hamilton Depression Rating Scale , and the Clinical Global Impressions rating scale were used as outcome measures . RESULTS Thirty-one subjects were r and omized ( 18 AMI , 13 placebo ) . Twenty-two subjects were study completers ( 12 AMI , 10 placebo ) . AMI 's efficacy was suggested by the Clinical Global Impressions but not the K-SADS-derived data . Perhaps the primary limitation of the current study is its small sample size . CONCLUSION No definitive recommendation can be made regarding the efficacy of tricyclic antidepressants in the treatment of adolescent MDD OBJECTIVE The safety , efficacy , and tolerability of venlafaxine extended release ( ER ) in subjects ages 7 to 17 years with major depressive disorder were evaluated in two multicenter , r and omized , double-blind , placebo- 
    Output:
    
The adverse effects most associated with dropout were attempted suicide followed by mania , skin rash , and headache .
Problems relating to clinical trials and family arbitration were also related with dropout .
Selective serotonin reuptake inhibitors were linked to the lowest prevalence , probably due to fewer perceived problems with related adverse effects and higher efficacy in adolescents .
Cognitive-behavioral therapy combined with pharmacotherapy produced a lower nonadherence prevalence ; this approach can be an alternative to avoid dropouts and relapse .