Exercise Treatment for Depressed Youth

描述（由申请人提供）：重度抑郁症（MDD）在青少年中很常见，并导致显著的发病率和死亡率。青少年自杀是这个年龄组的第三大死亡原因，通常由抑郁症引起。最常用的抗抑郁药（SSRIs）只有部分反应的比率很高，并且关于其在该年龄组中的使用的争议越来越多。这些发现加上最近SSRI处方率下降，自杀率随之增加，构成了一个重要的公共卫生问题。对于青少年来说，缺乏安全、有效、易于使用的非药物治疗替代品。有氧运动可以提供一种安全、有效、副作用最小的治疗干预，可能更容易被患者接受，并且可能具有成本效益。本研究建议：1）根据最近成功的UT西南抑郁症成人运动研究，制定抑郁症青少年运动治疗手册，2）根据依从性和完成率，评估使用标准化有氧运动方案治疗非药物临床抑郁症青少年的可行性，3）建立主要结果（CDRS-R和Actical [能量消耗数据]以及选定的次要结果的效应量; [例如，QIDS-A17，态度]，和4）确定运动与伸展活动是否导致抑郁症状的临床有意义的减少和/或心理社会功能的改善。拟议的研究将包括向从社区医生、广告和UT西南门诊招募的轻度至中度抑郁的未服药青少年提供有氧运动或安慰剂伸展。将60名年龄在12 - 17岁之间、符合DSM-IV重度抑郁症标准（CDRS-R = 36 =70和CDI-S = 4）的临床抑郁青少年随机分为有氧运动组或安慰剂拉伸组，持续12周。根据目前的招募情况，以及在达拉斯的库珀研究所进行的UT西南成人抑郁症运动研究中所达到的比率，我们预计至少有60人将在规定的时间内随机参加为期12周的探索性可行性试验。利用基于网络的工具和Actical 24/7监测来监测遵守情况的综合最先进的过程，再加上针对抑郁青年的激励技术，以确保成功完成率。

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.