Psychotherapy for depression among children and adolescents
Watanabe N, Hunot V, Omori IM, Churchill R, Furukawa TA
The Bottom Line:
There is evidence that some forms of psychotherapy, or talk therapy, works to relieve moderate to severe symptoms of depression in 12- to 18-year-olds. Cognitive behavioural therapy and interpersonal therapy were found to have the best outcomes but not past six months. We do not know if CBT/interpersonal psychotherapy can prevent recurrence of depression. |
What problem is being addressed?
If left untreated, depression in children and adolescents can have lifelong personal, school, and work life consequences. Treatment is crucial to prevent these negative effects. Although there is a lot of media attention focused on drug treatment of depression in youngsters, there are other therapies available. Psychotherapy, or “talk therapy” has been used for decades, but there has been little research comparing it to either no treatment or to placebos.
What intervention is being tested?
This study looked at whether or not psychotherapy successfully treated depression in 6- to 18-year-olds. Psychotherapy in this review means therapies like Cognitive Behavioural Therapy (CBT) (or either behavioural therapy or cognitive therapy), interpersonal therapy, supportive therapy, problem-solving therapy, or psychodynamic therapy. The goal of any of the therapies had to be reduction in symptoms of depression that meant the child or adolescent no longer met criteria for the condition. The authors also looked at adverse effects and the economic costs of the therapy.
What is the real scientific evidence?
1744 participants in 35 randomized controlled trials (RCTs). Twenty-five studies looked at CBT, 2 looked at cognitive therapy; three looked at behavior therapy; two were studies of interpersonal therapy; and one each looked at problem solving therapy, psychodynamic therapy, or supportive therapy. Control groups consisted of children and adolescents on waiting lists for treatment, those engaged in therapies other than those being researched and “attention-placebo”, that is, treatments that are not known to have positive effects on depression (e.g., art therapy, psychodrama, health education) or no treatment at all.
The review found that CBT and interpersonal therapy are effective in alleviating symptoms of depression in 12- to 18-year-olds, and in adolescents with moderate to severe depression but not mild to moderate depression. Patients receiving psychotherapy improved more than those on waiting lists or those receiving art therapy or health educationfor at least six months after treatment. None of the studies reported on adverse effects or cost-effectiveness.
The preceding is a summary of:
Watanabe N, Hunot V, Omori IM, Churchill R, Furukawa TA. Psychotherapy for depression among children and adolescents: a systematic review. Acta Psychiatrica Scandinavica. 2007; 116: 84-95.
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