Depressed Adolescents Need Longer Stretches of Therapy
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
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."