Exercise Treatment for Depressed Youth

描述(由申请人提供)：严重抑郁障碍(MDD)在青少年中很常见，导致严重的发病率和死亡率。青少年自杀是这个年龄段的第三大死亡原因，通常由抑郁症引起。对最常用的抗抑郁药(SSRI)只有很高的部分应答率，关于该年龄段使用这些药物的争议也越来越大。这些发现加上最近SSRI处方率的下降和随之而来的自杀人数的增加，构成了一个重要的公共卫生问题。对于青少年来说，缺乏可用的、安全、有效和易于使用的非药物治疗替代方案，具有受控数据。有氧运动可以提供一种安全、有效、副作用最小的治疗干预措施，患者可能更容易接受，而且可能具有成本效益。这项研究建议1)根据最近成功的德克萨斯大学西南部抑郁症成人运动研究开发一份抑郁青少年运动治疗手册，2)根据坚持和完成率评估使用标准化有氧运动方案治疗非药物临床抑郁青少年的可行性，3)建立主要结果(CDRS-R和实际[能量消耗数据]以及选定的次要结果；[例如，QDS-A17，态度]的影响大小，以及4)确定运动与拉伸活动是否能在临床上有意义地减少抑郁症状和/或改善心理社会功能。这项拟议的研究将包括向从社区医生、广告和德克萨斯大学西南门诊部招募的轻度至中度抑郁的非药物青少年提供有氧运动或安慰剂拉伸。将60名符合DSM-IV重度抑郁症标准(CDRS-R=36=70，CDI-S=4)的12-17岁男女临床抑郁青少年随机分为有氧剂量运动或安慰剂拉伸状态，为期12周。根据目前的招募情况和达拉斯库珀研究所进行的德克萨斯大学西南成人抑郁症锻炼研究的成功率，我们预计至少有60人将在分配的时间内随机参加12周的探索性可行性试验。通过基于网络的工具监测遵守情况的全面最先进的程序和24/7全天候的实际监测与针对抑郁青年的激励技术相结合，以确保成功完成。

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is common in adolescents and results in significant morbidity and mortality. Adolescent suicides are the third leading cause of death for this age group typically accounted for by depression. There is a high rate of only partial response to the most commonly used group of antidepressants (SSRIs) and increased controversy regarding their use for this age group. These findings coupled with recent decreased SSRI prescription rates with concomitant increases in suicide, constitutes an important public health problem. And for adolescents, there is a lack of available safe, effective, and easy to use nonmedication treatment alternatives with controlled data. Aerobic exercise can provide a safe, effective, minimal side effect treatment intervention that may be more acceptable to patients and potentially cost effective. This study proposes to 1) develop a depressed adolescent exercise treatment manual based on the recent successful UT Southwestern depressed adult exercise study, 2) evaluate the feasibility of using a standardized aerobic exercise regime to treat nonmedicated clinically depressed adolescents based on adherence and completion rates, 3) establish effect sizes for the primary outcome (the CDRS-R and Actical [energy expenditure data] as well as selected secondary outcomes; [e.g., QIDS-A17, attitudes], and 4) determine whether exercise versus stretching activity leads to clinically meaningful reduction in depressive symptoms and/ or improved psychosocial functioning. The proposed study will consist of providing AEROBIC EXERCISE or PLACEBO STRETCH to mild to moderately depressed nonmedicated adolescents recruited from community physicians, advertisements, and UT Southwestern outpatient clinics. Sixty clinically depressed adolescents of both genders between the ages of 12 -17 years who meet criteria for DSM-IV major depression (CDRS-R = 36 =70 and CDI-S = 4) will be randomized to an aerobic dose exercise or a placebo stretch condition for 12 weeks. Based on current recruitment, and rates achieved in the UT Southwestern adult depression exercise study at the Cooper Institute in Dallas, we anticipate at least 60 will be randomized to the 12 weeks exploratory feasibility trial in the allotted time. Comprehensive state of the art processes for monitoring adherence with web-based tools and Actical 24/7 monitoring are coupled with motivational techniques for depressed youth to assure a successful completion rate.