Depressed teens who initially declined antidepressants and received brief cognitive behavioral therapy (CBT) in a primary care setting were more likely to recover, and to recover faster, compared with similar young people who received usual care but not CBT, according to a randomized study of 212 adolescents.
From 10% to 15% of adolescents experience depression each year, and many refuse to take antidepressants or stop them before they have a chance to work. One alternative is a referral to a mental health specialty clinic; however, less than 30% of teens and their parents follow up on these referrals, according to Greg Clarke, Ph.D., of Kaiser Permanente Center for Health Research, and his colleagues.
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Brief CBT offered small to moderate clinical benefit that persisted for at least 1 year. On average, teens in the CBT program recovered 7 weeks faster (22.6 weeks vs. 30 weeks) and in higher numbers (33% more recovery) compared with teens who didn’t receive CBT. After 6 months, 70% of teens in the CBT program had recovered, compared with 43% of teens not in the program.
By the end of the 2-year study, 89% who received CBT counseling and 79% in the standard care group had recovered (Pediatrics 2016 May. doi: 10.1542/peds.2015-1851).
But the youth in the CBT group were 10 times less likely to be hospitalized. “We were not surprised that CBT helped improve depression, but the much lower rates of psychiatric hospitalization was a welcome surprise. Offering brief CBT in primary care is an effective alternative with good results,” Dr. Clarke said in an interview.
Study participants had a diagnosis of major depression obtained via the Children’s Schedule for Affective Disorders and Schizophrenia (KSADS). Youth were randomized to either self-selected treatment (i.e., outpatient mental health, medication, school counseling, treatment for alcohol or drug abuse) or to self-selected treatment plus a 5- to 9-week CBT program within their primary care clinics. Counselors used traditional CBT techniques to help teens challenge depressive thoughts and replace those beliefs with more realistic, positive approaches.
Randomization was stratified by baseline depression severity, gender, Hispanic ethnicity, and age (12-15 years vs. 16-18 years). Researchers assessed these young people at baseline and followed them for 2 years, having them fill out follow-up surveys at 6, 12, 26, 52, 78, and 104 weeks. Those who assessed the surveys did not know which teens received CBT.
The acute-phase CBT program consisted of two four-session modules: cognitive therapy to address unrealistic thinking, and increasing pleasant activities (behavioral activation). Of those attending any sessions, 66% of 102 received at least one session of cognitive therapy, 62% received at least one session of behavioral activation, and 45% received both.
The National Institutes of Health funded the study. The researchers had no relevant disclosures.