Clinical Effectiveness of TARA Compared to Standard Treatment for Adolescents and Young Adults With Depression (TARA)
Depression in Adolescence, Depressive Disorder, Dysthymia and Chronic Depression
About this trial
This is an interventional treatment trial for Depression in Adolescence focused on measuring young people, RCT, yoga, cognitive behavioural therapy, selective serotonin reuptake inhibitor, psychotherapy, biological markers, antidepressant, meditation, Magnetic resonance imaging, Emotion regulation
Eligibility Criteria
Inclusion Criteria:
- Outpatient at the CAP or YC unit
- The criteria for a diagnosis Major Depressive Disorder (MDD) or Persistent Depressive disorder (PDD)/dysthymia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV or 5 are fulfilled. The clinical diagnosis will be validated during the screening process using the Mini International Neuropsychiatric Interview (M.I.N.I.)/Mini-International Neuropsychiatric Interview for Children and Adolescents (M.I.N.I-kid). If a diagnosis of MDD or PDD/dysthymia is not conclusive a cut-off of 40 or above on the Children's' Depression Rating Scale - Revised will be used for inclusion.
- For patients in specialist child- and adolescent psychiatry clinics below the age of 18 one parent/ legal guardian must be available and agree to participate in parts of the sessions in case the individual is randomized to the TARA-arm.
Exclusion Criteria:
- One or several severe psychiatric co-morbid diagnoses that may interfere with or hinder group participation, including: intellectual development disorder, severe autism spectrum disorder, psychotic disorder, bipolar disorder, severe anorexia nervosa, substance use disorders, acute posttraumatic stress disorder (PTSD) and severe dissociative syndromes.
One or several psychiatric symptoms or behavioral problems that may interfere with or hinder group participation including:
- Severe self-harming behavior
- Acute suicidality, including a reported suicide attempt in the last 6 months or hospitalization for suicidality in the last 6 months
- Disabling dissociative symptoms or > 6 points as mean item score on the Adolescent Dissociative Experiencing Scale.
- Frequent use of recreational drugs (a urine drug screen will be performed at baseline and if positive a second test has to be negative for inclusion)
- Reports of manic or hypomanic symptoms during the last year
- A first degree relative with bipolar disorder (a first episode of MDD may be an incipient bipolar disorder which is not the treatment target for TARA).
- On-going trauma, neglect, abuse or domestic violence or destabilizing legal process.
- Pregnancy
- Non-fluency in oral and written Swedish since the TARA groups are held in Swedish and assessment forms are in Swedish
Note:
Other psychiatric comorbidities such as attention deficit hyperactivity disorder (ADHD), anxiety, high functioning autism spectrum disorder and mild to moderate eating disorders are not considered exclusion criteria.
Accidental findings of biochemical anomalies will not be considered exclusion criteria and medical conditions will be referred for appropriate treatment.
Sites / Locations
- Ungdomshälsan
- Barn och Ungdomspsykiatriska kliniken
- UngdomshälsanRecruiting
- Barn och Ungdomspsykiatriska klinikenRecruiting
- Barn och Ungdomspsykiatriska kliniken
- Barn och Ungdomspsykiatriska kliniken
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Training for Awareness, Resilience and Action (TARA)
Standard Treatment
12 weekly online sessions, each 90 minutes, 6 participants/group. For participants <18 years at CAP, parents/legal guardians will participate in parts of the sessions. Manual-based: Session 1: Introducing group members; establishing guidelines; investigating attitudes and previous experiences, introducing contemplative practices. All sessions: participants sit on yoga mats. Facilitators open and briefly check-in. Participants are guided through a breathing practice, yoga-based movement (a flow of positions synchronized with the breath) and then a meditation focusing primarily on interoceptive and sensory awareness. After a short break, a psychoeducational presentation is held followed by group exercises and discussions. The sessions conclude with feedback and questions regarding the practice, followed by a description of the home practice for the coming week. Finally, participants gather their attention and have the opportunity to express their reflections and current state.
Standard treatment (ST) as given at each participating study site. ST is based on the health practitioners' knowledge, experience, current guidelines and both the practitioners' and participants' preferences. For young people with depression The Swedish National Board of Health and Welfare recommends social support and psychoeducation (as first priority), Selective Serotonin reuptake inhibitors (as second priority) and cognitive behavioral therapy (as second priority). These recommendations are generally followed and given as stand-alone treatment or in different combinations. In our study we have no control over which of these treatments are given in the ST-arm, nor the combination or timing of them. To obtain data on what treatment has been given in the ST-arm we will go through the individual medical records of all participants at the conclusion of data collection.