For Young People With Depression, Psychotherapy Helps, Somewhat

By Lorraine L. Janeczko

NEW YORK—Psychotherapy improves the lives of young people with depression as modestly as it did 13 years ago, according to a new report.

"This meta-analysis of youth depression psychotherapy RCTs (randomized controlled trials), following up on a similarly structured meta-analysis published 13 years ago, with a substantial increase in the number of studies included, showed a strikingly similar pattern of findings, with a similarly modest level of treatment benefit," the authors write in the Journal of the American Academy of Child and Adolescent Psychiatry, online April 17.

Dr. Dikla Eckshtain of Massachusetts General Hospital and Harvard Medical School in Boston and her colleagues searched PubMed, PsychINFO, and Dissertation Abstracts International from 1960 through 2017. They found 55 randomized, English-language psychotherapy trials involving patients 4 through 18 years of age that compared psychotherapy with control for youth depression with outcomes in both groups measured in both groups at post and/or follow-up.

The research team extracted 12 study and outcome traits and calculated effect sizes for all comparisons, using a three-level random-effects approach. The overall effect size (Hedges' g) was 0.36 at after treatment and 0.21 at follow-up an average of 42 weeks later.

The effects were significantly greater for interpersonal therapy for adolescents (IPT-A) than cognitive behavioral therapy (CBT); for youth self-reported outcomes than parent reports; and for comparisons with inactive control conditions such as waitlists than active controls such as usual care.

Effects for anxiety and externalizing behavior were significantly smaller than for depression.

Dr. Girwan Khadka, a child psychologist at Children's Mercy Hospital in Kansas City, Missouri, who was not involved in the study, said, "One aspect of the study that shouldn't be lost in the academic jargon is that the meta-analysis affirms the tenets of CBT and IPT-A as effective psychotherapeutic interventions for depression in youth."

"Evidence-based psychotherapies continue to effectively alleviate symptoms of depression in youth," he told Reuters Health by email.

Child and adolescent psychiatrist Dr. Lindsay S. Tobler, also at Children's Mercy Hospital in Kansas City, said many of her patients with depression have comorbidities, but studies in this meta-analysis did not consistently report them.

While CBT and IPT-A showed modest effect size, she told Reuters Health by email, "comorbid mental health concerns may require a different or complimentary treatment modality."

The study had no commercial funding.

Dr. Eckshtain was not able to provide comments by press time.

SOURCE: https://bit.ly/2GXiCgU

J Am Acad Child Adolesc Psychiatry 2019.

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