Depression is a chronic illness in children and adolescents that often leads to long-term difficulties with recurrent episodes of depression. Standard treatment must continue beyond acute symptom reduction to a chronic disease management model, such as those used in pediatric asthma and diabetes. Within the chronic disease management model, treatment interventions are directed not only at the urgent or acute concern but also at the prevention of future problems. Lack of consistent efficacy in acute treatment studies has limited long-term prevention treatment research in pediatric depression. The impact of long-term treatments, both psychosocial and pharmacologic, is currently unknown.