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Cognitive behavioral therapy offers adolescents with depression some benefit over treatment with antidepressants alone

Approximately 35 to 65 percent of adolescents diagnosed with depression are considered fully recovered at the end of treatment with selective serotonin reuptake inhibitors (SSRIs), a newer class of antidepressants. Combining brief cognitive-behavioral therapy (CBT) with SSRIs adds some small improvement for adolescents with depression, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10535 and HS13854).

Gregory Clarke, Ph.D., of the Kaiser Permanente Center for Health Research, and colleagues randomly assigned 152 adolescents (aged 12 to 18) with major depressive disorder in treatment at an HMO pediatric primary care practice to either a treatment-as-usual group consisting primarily of SSRI medication or to an SSRI plus brief CBT group (5 to 9 sessions).

The CBT program employed cognitive restructuring and/or behavioral activation training by an on-site mental health specialist, who collaborated with the primary care provider. Therapists in the CBT program made brief "check-in" phone calls to the adolescents at 1, 2, 3, 5, 7, and 9 months after completing the initial sessions. The researchers detected a marginal trend favoring the CBT condition on one depression scale, but failed to find any advantage in recovery from major depressive disorder.

Adolescents in the CBT treatment used approximately 20 percent less medication than the treatment-as-usual group, which may have masked the potential advantages of CBT. The researchers note that these results are consistent with recent studies suggesting that depressed youths only reluctantly take antidepressant medication and look for opportunities to discontinue it.

More details are in "A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication," by Dr. Clarke, Lynn Debar, Ph.D., Frances Lynch, Ph.D., and others, in the September 2005 Journal of the American Academy of Child and Adolescent Psychiatry 44(9), pp. 888-898.

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