Provided by Clinician Reviews
Cognitive behavioral (CB) therapy that teaches coping and problem-solving skills may effectively reduce the incidence of depressive episodes in at-risk teens (ie, those who have a parent with a history of depression). By comparing their data to those from other clinical trials, Garber and colleagues determined that the CB prevention program tested in their study had a preventive effect similar to that of antidepressant treatment. However, the researchers observed, “The prevention of a disorder may bring even greater benefit to adolescents and to the public than the amelioration of an acute depressive episode after it has produced other negative consequences.”
A total of 316 adolescents (ages 13 to 17) were randomly assigned either to receive usual care or to participate in CB therapy. In addition to a parental history of depression, eligible patients had a personal history of depression, elevated but subdiagnostic scores on depression-symptom scales, or both. More than half of study participants were female, and about one-quarter identified themselves as members of a racial or ethnic minority.
The CB therapy program included eight weekly 90-minute sessions, during which teens were taught cognitive restructuring techniques and problem-solving skills. At six additional monthly group sessions, previously learned skills were reviewed and new skills taught, including behavioral activation, relaxation, and assertiveness.
The primary outcome of incident depression was lower in the CB therapy group than in the usual care group, both in terms of the rate (21.4% and 32.7%, respectively) and the hazard ratio (HR; 0.63). Changes in self-reported depressive symptoms were also significantly better for teens receiving CB therapy.
Parents’ current mental health status impacted the effectiveness of CB therapy in their children. Among teens whose affected parent was not currently depressed, CB therapy was significantly better than usual care in preventing depressive episodes (incidence, 11.7% and 40.5%, respectively; HR, 0.24). Among teens with a currently depressed parent, there was no significant difference between the CB therapy group and the usual care group in the incidence of or risk for depressive episodes.
Nonetheless, Garber and colleagues conclude that their findings “support the clinical utility of this … program as a preventive intervention to reduce or delay the incidence of depression in offspring of depressed parents.”
Garber J, Clarke GN, Weersing VR, et al. Prevention of depression in at-risk adolescents: a randomized controlled trial.
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