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Depressed Adolescents Need Longer Stretches of Therapy

WebMD Health News

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.

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