Combined treatment with cognitive-behavioural therapy in adolescent depression: meta-analysis.
BACKGROUND
The treatment of adolescent depression is controversial and studies of combined treatment (antidepressants and cognitive-behavioural therapy, CBT) have produced conflicting findings.


OBJECTIVE
To address the question of whether CBT confers additional benefit to antidepressant treatment in adolescents with unipolar depression for depressive symptoms, suicidality, impairment and global improvement.


METHODS
Meta-analysis of randomised controlled trials (RCTs) of newer-generation antidepressants and CBT in adolescent depression.


RESULTS
There was no evidence of a statistically significant benefit of combined treatment over antidepressants for depressive symptoms, suicidality and global improvement after acute treatment or at follow-up. There was a statistically significant advantage of combined treatment for impairment in the short-term (at 12 weeks) only. There was some evidence of heterogeneity between studies.


CONCLUSIONS
Adding CBT to antidepressants confers limited advantage for the treatment of an episode of depression in adolescents. The variation in sampling and methodology between studies, as well as the small number of trials, limits the generalisability of the findings and any conclusions that can be drawn. Future studies should examine predictors of response to treatment as well as clinical components that may affect outcome.
Lancashire Care Foundation Trust and Psychiatry Research Group, School of Community Based Medicine, University of Manchester, UK. Bernadka.Dubicka@manchester.ac.uk
Bernadka
B
Dubicka
Rachel
R
Elvins
Chris
C
Roberts
Greg
G
Chick
Paul
P
Wilkinson
Ian M
IM
Goodyer
D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy / Q000379:methods; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D016896:Treatment Outcome
D017367:Selective Serotonin Reuptake Inhibitors