Review: psychotherapy for adolescents with depression: initial but no sustainable benefits.

ED FROM Watanabe N, Hunot V, Omori IM, et al. Psychotherapy for depression among children and adolescents: a systematic review. Acta Psychiatr Scand 2007;116:84–95. Correspondence to: Norio Watanabe, Department of Psychiatry and Cognitive Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku Nagoya 467-8601, Japan; [email protected] Source of funding: The Cochrane Child Health Field Bursay Scheme. c Additional notes and a reference list are published online only at http:// ebmh.bmj.com/content/vol11/issue2 C O M M EN TA R Y T his rigorous review addressed the issue of the effectiveness of psychotherapy in the treatment of depression in children and adolescents. It is worth noting that the review includes a particularly large study on targeted depression prevention which excluded young people with depressive disorder, thus reducing the chance of showing an effect for psychotherapy. The results provide evidence that cognitive behaviour therapy (CBT), interpersonal therapy (IPT) and possibly behaviour therapy (BT) are effective, at least for adolescents. The response rates on metaanalysis (49.6% psychotherapy vs 34.8% control) compare well with antidepressants. The psychotherapy studies have used self-rating scales of depressive symptoms. Studies of antidepressants have used clinician rated scales as primary outcomes and most have failed to show a difference on self-rating scales (using similar measures). Had clinician rating scales been used the results from psychotherapy might have been even better. A difference in outcome at short-term follow-up (1–6 months) would have been expected with effective therapy, and failure to show this is of some concern, while the failure to show a difference at longer term follow-up (6–12 months) may well reflect a catch-up from spontaneous remission in the comparison group. The authors rightly identify weaknesses in the current studies and point out the lack of information on cost-effectiveness and on the potential for harm. However, until more rigorous studies are done this review supports the continued use of CBT and IPT, and probably BT for depression in children and adolescents. The challenge remains. Neither psychotherapy nor medication result in high rates of remission for depressive disorder. The quest for more effective therapies goes on. In the meantime, this review provides evidence to support the continued use of CBT and IPT in depression in adolescents, in line with the NICE guidelines. The issue is less clear for children. Sally N Merry, MB, ChB, FRANZCP, MD Werry Centre for Child and Adolescent Mental Health, University of Auckland, Auckland, New Zealand Competing interests: None. Therapeutics EBMH May 2008 Vol 11 No 2 49 group.bmj.com on June 19, 2017 Published by http://ebmh.bmj.com/ Downloaded from