A CLINICAL PSYCHOTHERAPY TRIAL FOR ADOLESCENT DEPRESSION COMPARING COGNITIVE, FAMILY, AND SUPPORTIVE THERAPY

Background: Previous studies in nonclinical samples have shown psychos ocial treatments to be efficacious in the treatment of adolescent depr ession, but few psychotherapy treatment studies have been conducted in clinically referred, depressed adolescents. Methods: One hundred seve n adolescent patients with DSM-III-R major depressive disorder (MDD) w ere randomly assigned to 1 of 3 treatments: individual cognitive behav ior therapy, systemic behavior family therapy (SBFT), or individual no ndirective supportive therapy (NST). Treatments were 12 to 16 sessions provided in as many weeks. Intent-to-treat analyses were conducted us ing all follow-up data. Results: Of the 107 patients enrolled in the s tudy, 78 (72.9%) completed the study, 4 (3.7%) never initiated treatme nt, 10 (9.3%) had exclusionary criteria that were undetected at entry, 8 (7.5%) dropped out, and 7 (6.5%) were removed for clinical reasons. Cognitive behavior therapy showed a lower rate of MDD at the end of t reatment compared with NST (17.1% vs 42.4%; P=.02), and resulted in a higher rate of remission (64.7%, defined as absence of MDD and at leas t 3 consecutive Beck Depression Inventory scores <9) than SBFT (37.9%; P=.03) or NST (39.4%; P=.04). Cognitive behavior therapy resulted in more rapid relief in interviewer-rated (vs both treatments, P=.03) and self-reported depression (vs SBFT, P=.02). All 3 treatments showed si gnificant and similar reductions in suicidality and functional impairm ent. Parents' views of the credibility of cognitive behavior therapy i mproved compared with parents' views of both SBFT (P=.01) and NST (P=. 05). Conclusion: Cognitive behavior therapy is more efficacious than S BFT or NST for adolescent MDD in clinical settings, resulting in more rapid and complete treatment response.