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Cognitive behavioral therapy effective treatment for youth depression in primary care

Cognitive behavioral therapy, used as an alternative to antidepressants, provided an important clinical benefit for adolescent patients with major depression in primary care settings, and could reduce the risk of future recurrent depression episodes, according to data published in Pediatrics.

“Adolescent depression is often initially identified in primary care, and is increasingly treated there, typically with antidepressant medications,” Gregory Clarke, MD, of the Kaiser Permanente Center for Health Research, in Portland, Oregon, and colleagues wrote. “However, a 2004 warning from the Food and Drug Administration regarding [antidepressant]-associated suicidality contributed to reduced prescription of [antidepressants] over many years, with no corresponding increase in psychotherapy rates. Among depressed youth in primary care, as many as 50% decline pharmacotherapy.”

To determine whether brief cognitive behavioral therapy (CBT) can be an effective alternative to antidepressants in primary care, the researchers conducted a randomized study with 212 adolescents aged 12 to 18 years with major depression who had recently declined or quickly discontinued new antidepressant treatment. The participants self-selected placement in either the treatment-as-usual control group, or treat as usual in addition to brief, individual CBT.

Blinded evaluators followed participants for 2 years. The primary outcome was time to major depression diagnostic recovery.

According to the researchers, CBT was superior to the control condition in time to diagnostic recovery from major depression, with number needed to treat from four to 10 across the follow-up period. CBT also provided an advantage in time to depression diagnosis response, with number needed to treat of five to 50 across the follow-up. In addition, the researchers reported significant advantages to CBT treatment for many secondary outcomes during the first year of follow-up, but not the second year. Effect sizes for significant continuous measures ranged from 0.28 to 0.44, in the small-to-medium effect range. Psychiatric hospitalizations occurred at a significantly higher rate among participants in the control group throughout the first year of follow-up.

“One implication for clinical practice is that brief CBT can be delivered in primary care to depressed youth who have initially declined [antidepressants],” Clarke and colleagues wrote. “Also, our results indicate that brief CBT can impart small-to-moderate clinical benefit above and beyond [treatment as usual] health services, and that this benefit persists for at least 1 year after baseline.” – by Jason Laday

Disclosure: Clarke reports being a paid employee of the Kaiser Permanente Center for Health Research. See the full study for additional author disclosures.