A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression.
OBJECTIVE
To evaluate cognitive-behavioral therapy, antidepressant medication alone, and combined CBT and antidepressant medication in the treatment of depressive disorders in adolescents.


METHODS
Seventy-three adolescents (ages 12-18 years) with a primary diagnosis of DSM-IV major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified were randomly allocated to one of three treatments. Treatment outcome measures were administered before and after acute treatment, and at a 6-month follow-up. Depression diagnosis was the primary outcome measure; secondary measures were self- and other report and clinician rating of global functioning. The trial was conducted at three community-based clinics between July 2000 and December 2002. Data analyses used an intent-to-treat strategy.


RESULTS
Following acute treatment, all treatment groups demonstrated statistically significant improvement on outcome measures (depressive diagnosis, Reynolds Adolescent Depression Scale, Revised Children's Manifest Anxiety Scale, Suicidal Ideation Questionnaire), and improvement was maintained at follow-up. Combined cognitive-behavioral therapy and antidepressant medication was not found to be superior to either treatment alone. Compared with antidepressant medication alone, participants receiving cognitive-behavioral therapy alone demonstrated a superior acute treatment response (odds ratio = 6.86; 95% confidence interval 1.12-41.82). Although cognitive-behavioral therapy was found to be superior to antidepressant medication alone for the acute treatment of mild to moderate depression among youth, this may have stemmed from the relatively low dose of sertraline used.


CONCLUSIONS
All treatments led to a reduction in depression, but the advantages of a combined approach were not evident.
Melvin
Glenn A
GA
Drs. Melvin, Tonge, Gordon, and Klimkeit are with the Centre for Developmental Psychiatry and Psychology and Dr. King is with the Faculty of Education, Monash University, Australia; and Dr. Heyne is with Developmental and Educational Psychology, Leiden University, The Netherlands. Electronic address: glenn.melvin@med.monash.edu.au.
Tonge
Bruce J
BJ
Drs. Melvin, Tonge, Gordon, and Klimkeit are with the Centre for Developmental Psychiatry and Psychology and Dr. King is with the Faculty of Education, Monash University, Australia; and Dr. Heyne is with Developmental and Educational Psychology, Leiden University, The Netherlands.
King
Neville J
NJ
Drs. Melvin, Tonge, Gordon, and Klimkeit are with the Centre for Developmental Psychiatry and Psychology and Dr. King is with the Faculty of Education, Monash University, Australia; and Dr. Heyne is with Developmental and Educational Psychology, Leiden University, The Netherlands.
Heyne
David
D
Drs. Melvin, Tonge, Gordon, and Klimkeit are with the Centre for Developmental Psychiatry and Psychology and Dr. King is with the Faculty of Education, Monash University, Australia; and Dr. Heyne is with Developmental and Educational Psychology, Leiden University, The Netherlands.
Gordon
Michael S
MS
Drs. Melvin, Tonge, Gordon, and Klimkeit are with the Centre for Developmental Psychiatry and Psychology and Dr. King is with the Faculty of Education, Monash University, Australia; and Dr. Heyne is with Developmental and Educational Psychology, Leiden University, The Netherlands.
Klimkeit
Ester
E
Drs. Melvin, Tonge, Gordon, and Klimkeit are with the Centre for Developmental Psychiatry and Psychology and Dr. King is with the Faculty of Education, Monash University, Australia; and Dr. Heyne is with Developmental and Educational Psychology, Leiden University, The Netherlands.
D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020280:Sertraline / Q000627:therapeutic use*
D000928:Antidepressive Agents; D020280:Sertraline