Does therapy for depression in teens decrease the likelihood of depression in adulthood

Abstract

Evidence summary Authors of a 2015 network meta-analysis of 52 prospective RCTs, including about 3,800 depressed adolescents, investigated efficacy of various psychotherapies. Nine different active therapies were randomized to about 60% of patients, with the remaining patients serving as control groups. Cognitive behavioral therapy (CBT) and interpersonal therapy were significantly effective (standardized mean differences of effect ranged from –0.26 to –1.05) for adolescents in a short followup period of 6 months or less. A standardized mean difference of 0.2 is generally considered small, 0.6 is considered moderate, and 1.2 is considered large. A 2013 Australia study focused on 140 adolescents with major depressive disorder (MDD), offering psychotherapy and/or antidepressant medication in a standardized process across 2 clinical trials. Most (92.6%) participants had a full remission within 2 years. However, recurrence was common (52.4%) an average of 5.7 years later, as were other disorders, including anxiety, substance abuse, and eating disorders. A 2011 follow-up study investigated recovery from and recurrence of MDD among participants in the Treatment for Adolescents with Depression Study (TADS). TADS compared fluoxetine, CBT, their combination, and a placebo; the combination therapy was determined to be most efficacious in the short term. The 5-year follow-up found that of 196 adolescents in the TADS, 189 recovered (96.4%). But of these who recovered, 46.6% had had a recurrence. Recurrence was not predicted by short-term treatment response or by original treatment. A prospective case-control study followed 134 participants, 91 diagnosed with MDD in adolescence at a hospital in New York City and 43 recruited from the community to make up a nonpsychiatrically ill control group. Psychotherapy was pursued, although treatment specifics were unclear. Approximately 10 to 15 years after initial assessment, researchers found 63% of the depressed group had another episode of MDD in adulthood versus 31% in the control group (relative risk 2.2; P<.05). The MDD group also had higher rates of suicide and suicide attempts (7.7%) and greater psychosocial impairments.