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，导致显著的发病率和死亡率。青少年自杀是这一年龄组的第三大死因，通常由抑郁症造成。对于最常用的抗抑郁药（SSRIs），只有部分反应的比例很高，这也增加了对该年龄组使用抗抑郁药的争议。这些发现加上最近SSRI处方率的下降和自杀率的增加，构成了一个重要的公共卫生问题。对于青少年，缺乏安全、有效和易于使用的非药物治疗替代方案，且数据可控。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，并且具有潜在的成本效益。本研究提出：1)基于最近成功的UT西南抑郁症成人运动研究，开发抑郁症青少年运动治疗手册；2)基于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practice[能量消耗数据]以及选定的次要结果的效应大小；[例如，QIDS-A17，态度]，以及4)确定运动与伸展活动是否会导致临床意义上的抑郁症状减轻和/或社会心理功能改善。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非药物青少年提供有氧运动或安慰剂拉伸。60名年龄在12 -17岁、符合DSM-IV重度抑郁症标准（CDRS-R = 36 =70, CDI-S = 4）的临床抑郁青少年将被随机分为有氧剂量运动组或安慰剂拉伸组，为期12周。根据目前的招募情况，以及达拉斯库珀研究所UT西南成人抑郁症运动研究的成功率，我们预计在分配的时间内，至少有60人将被随机分配到为期12周的探索性可行性试验中。采用基于网络的工具和实用的24/7全天候监测，采用先进的综合监测过程，并结合针对抑郁青少年的激励技术，确保成功完成治疗。

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.