A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication.
OBJECTIVE
To test a collaborative-care, cognitive-behavioral therapy (CBT) program adjunctive to selective serotonin reuptake inhibitor (SSRI) treatment in HMO pediatric primary care.


METHODS
A randomized effectiveness trial comparing a treatment-as-usual (TAU) control condition consisting primarily of SSRI medication delivered outside the experimental protocol (n = 75) versus TAU SSRI plus brief CBT (n = 77). Participants were identified by a recent dispense of SSRI medication followed by telephone screening. Adolescents with a diagnosis of major depressive disorder (n = 152) were enrolled. The CBT program employed cognitive restructuring and/or behavioral activation training. Therapists consulted with prescribing pediatricians to improve medication adherence.


RESULTS
Through 1-year follow-up, the authors found CBT advantages on the Short Form-12 Mental Component Scale (p = .04), reductions in TAU outpatient visits (p = .02), and days' supply of all medications (p = .01). No effects were detected for major depressive disorder episodes; a nonsignificant trend favoring CBT was detected on the Center for Epidemiology Depression Scale (p = .07).


CONCLUSIONS
The authors detected a weak CBT effect, possibly rendered less significant by the small sample and likely attenuated by the unexpected reduction in SSRI pharmacotherapy in the CBT condition. Small, incremental improvements over monotherapy, such as observed in this study, most likely represent the new norm in adolescent depression treatment research.
Clarke
Gregory
G
Kaiser Permanente Center for Health Research, Portland, OR 97227-1098, USA. greg.clarke@kpchr.org
Debar
Lynn
L
Lynch
Frances
F
Powell
James
J
Gale
John
J
O'Connor
Elizabeth
E
Ludman
Evette
E
Bush
Terry
T
Lin
Elizabeth H B
EH
Von Korff
Michael
M
Hertert
Stephanie
S
D000293:Adolescent; D000465:Algorithms; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
D017367:Selective Serotonin Reuptake Inhibitors