A Clinical Psychotherapy Trial for Adolescent Depression Comparing Cognitive, Family, and Supportive Therapy

TLDR

Psychosocial treatments are effective for adolescent depression in nonclinical samples, yet few trials exist for clinically referred depressed adolescents. One hundred seven clinically referred adolescents with DSM‑III‑R major depressive disorder were randomized to 12–16 sessions of cognitive‑behavior therapy, systemic behavior family therapy, or nondirective supportive therapy, and intent‑to‑treat analyses were performed. Cognitive‑behavior therapy produced a lower rate of major depressive disorder and higher remission than supportive or family therapy, achieved faster symptom relief, and was rated more credible by parents, while all three treatments similarly reduced suicidality and functional impairment.

Abstract

<h3>Background:</h3> Previous studies in nonclinical samples have shown psychosocial treatments to be efficacious in the treatment of adolescent depression, but few psychotherapy treatment studies have been conducted in clinically referred, depressed adolescents. <h3>Methods:</h3> One hundred seven adolescent patients with<i>DSM-III-R</i>major depressive disorder (MDD) were randomly assigned to 1 of 3 treatments: individual cognitive behavior therapy, systemic behavior family therapy (SBFT), or individual nondirective supportive therapy (NST). Treatments were 12 to 16 sessions provided in as many weeks. Intent-to-treat analyses were conducted using all follow-up data. <h3>Results:</h3> Of the 107 patients enrolled in the study, 78 (72.9%) completed the study, 4 (3.7%) never initiated treatment, 10 (9.3%) had exclusionary criteria that were undetected at entry, 8 (7.5%) dropped out, and 7 (6.5%) were removed for clinical reasons. Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST (17.1% vs 42.4%;<i>P</i>=.02), and resulted in a higher rate of remission (64.7%, defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores &lt;9) than SBFT (37.9%;<i>P</i>=.03) or NST (39.4%;<i>P</i>=.04). Cognitive behavior therapy resulted in more rapid relief in interviewer-rated (vs both treatments,<i>P</i>=.03) and self-reported depression (vs SBFT,<i>P</i>=.02). All 3 treatments showed significant and similar reductions in suicidality and functional impairment. Parents' views of the credibility of cognitive behavior therapy improved compared with parents' views of both SBFT (<i>P</i>=.01) and NST (<i>P</i>=.05). <h3>Conclusion:</h3> Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical settings, resulting in more rapid and complete treatment response.