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Is CBT an Alternative for Youth Depression?

Pediatrics; ePub 2016 May 1; Clarke, DeBar, et al

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An initial year of cognitive behavioral therapy (CBT) superiority in treating youth depression in primary care settings imparted an important clinical benefit and may reduce the risk of future recurrent depression episodes. This according to a study of 212 adolescents aged 12 to 18 years with major depression who had recently declined or quickly discontinued new antidepressant treatment and who were randomized to self-selected treatment as usual (TAU) control condition or TAU plus brief individual CBT and followed for 2 years. Researchers found:

• CBT was superior to control condition on the primary outcomes of time to diagnostic recovery from major depression, with number needed to treat from 4 to 10 across follow-up.

• A similar CBT advantage was found for time to depression diagnosis response, with number needed to treat of 5 to 50 across time points.

• There was a significant advantage for CBT on many secondary outcomes over the first year of follow-up, but not the second year.

Citation: Clarke G, DeBar LL, Pearson JA, et al. Cognitive behavioral therapy in primary care for youth declining antidepressants: A randomized trial. [Published online ahead of print May 1, 2016]. Pediatrics. doi:10.1542/peds.2015-1851.

Commentary: CBT is based on the premise that the way we think about events affects the way that we feel about those events, and ourselves. Dysfunctional thinking is common in many psychological disturbances, including depression. As individuals learn to evaluate their thinking in a more realistic and adaptive manner, their emotional and behavioral responses improve. CBT has a strong evidence base of efficacy and has been shown to be as effective as antidepressant medication with a lower rate of relapse of depression at the end of therapy.1,2 This study, which also showed that psychological hospitalization was less frequent with CBT (0.9% vs 8.5%), provides further support for the use of CBT for the treatment of depression, particularly in adolescents. —Neil Skolnik, MD

1. Keller MB, McCullough JP, Klein DN, et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. NEJM. 2000;342:1462.

2. Hollon SD, DeRubeis RJ, Shelton RC, et al. Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Arch Gen Psychiatry. 2005;62(4):417-22.

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