Depressed Adolescents Need Longer Stretches of Therapy

From the WebMD Archives

Jan. 13, 2000 (Washington) -- Adolescents with depression experienced recurrences of their symptoms after 2 years of intensive therapy, regardless of which of three common 'talking' therapies were used, according to a new study. The findings, which appear in the most recent issue of the Archives of General Psychiatry, show that therapy for depression needs to be ongoing and that family relationships must be addressed, one of the authors tells WebMD.

The study looked at the 2-year outcomes of 107 adolescents with major depression who were assigned to receive one of three types of therapy for 12-16 weeks: systemic behavioral family therapy, which focuses on changing family patterns of interacting; nondirective supportive therapy, which involves support without trying to change behavior and thought patterns; or cognitive behavioral therapy (CBT).

The latter "focuses on the relationship between feelings and behavior," David Brent, MD, a co-author of the study, tells WebMD, "and targets thinking patterns. People with depression may process information differently. They tend to focus on the negative. If you make people aware of those thinking patterns and try to correct them you can ameliorate [the depression]." Brent is a professor of child psychiatry at the University of Pittsburgh and is affiliated with the Western Psychiatric Institute and Clinic at Pittsburgh Medical Center.

The study builds on previously reported initial findings, which indicated that cognitive behavioral therapy was superior to family and supportive therapy in producing a faster rate of remission. Brent and his colleagues had hypothesized that the beneficial effect of cognitive behavioral therapy would last over a longer term, but that was not the case.

Based on these findings and others studies, "What I would say is that depression is a [long-term] disease, and it ought to be dealt with as a [long-term] disease," says Brent. Eighty percent of the adolescents in Brent's study recovered, 30% experienced a recurrence, regardless of therapy type, and 21% exhibited persistent depression during the 2-year follow-up period. This should prompt physicians to prepare parents and patients for the possibility of longer treatment stretches.

"You can't say for sure, but given that CBT worked better to begin with ... you probably need to have 4 to 6 monthly treatments to consolidate things. And you need to address the family difficulties head-on," Brent says.


John Sargent, MD, dean of the Karl Menninger School of Psychiatry and Mental Health Sciences in Topeka, Kan., had high praise for the study.

"What I am getting from the study are several things: that there are degrees of severity of depression in teen-agers; that it is often a chronic condition, that in teen-agers who are depressed, [most] recover with treatment, which is good; [and] that CBT leads more to recover initially but not over time. The degree of family conflict, degree of hopelessness, degree of functional difference ... those variables have a lot more to do with how the teen-ager does over time."

Sargent goes on to point out, that in terms of length of therapy offered, the initial research "did exactly what most insurance companies provide [for], and what they found is that it works for half the people. And that is pretty awful." Sargent, who is also the director of education and research at the Menninger Clinic, was not involved in any of the research.

The next research project for Brent and colleagues is to study the various options for treatment of depression in adolescents who fail to respond to the ever more common use of antidepressants.

The study was supported by grants from the National Institutes of Mental Health.

Vital Information:

  • One-fifth of adolescents who are treated for major depression with 'talking' therapy remain depressed after 2 years, regardless of the type of therapy used.
  • Initial research showed that cognitive behavioral therapy worked better than either systemic behavioral family therapy or nondirective supportive therapy, but the new research shows that the effect is not sustained.
  • Researchers interpret the findings to imply that depression should be seen as a long-term disease.
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