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David A. Brent, MD; Diane Holder, MSW; David Kolko, PhD; Boris Birmaher, MD; Marianne Baugher, MA; Claudia Roth, MSW; Satish Iyengar, PhD; Barbara A. Johnson, MD

Arch Gen Psychiatry. 1997;54(9):877-885.

Abstract
Background
Previous studies in nonclinical samples have shown psychosocial treatments to be efficacious in the treatment of adolescent depression, but few psychotherapy treatment studies have been conducted in clinically referred, depressed adolescents.

Methods
One hundred seven adolescent patients with DSM-III-R major depressive disorder (MDD) were randomly assigned to 1 of 3 treatments: individual cognitive behavior therapy, systemic behavior family therapy (SBFT), or individual nondirective supportive therapy (NST). Treatments were 12 to 16 sessions provided in as many weeks. Intent-to-treat analyses were conducted using all follow-up data.

Results
Of the 107 patients enrolled in the study, 78 (72.9%) completed the study, 4 (3.7%) never initiated treatment, 10 (9.3%) had exclusionary criteria that were undetected at entry, 8 (7.5%) dropped out, and 7 (6.5%) were removed for clinical reasons. Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST (17.1% vs 42.4%; P=.02), and resulted in a higher rate of remission (64.7%, defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores <9) than SBFT (37.9%; P=.03) or NST (39.4%; P=.04). Cognitive behavior therapy resulted in more rapid relief in interviewer-rated (vs both treatments, P=.03) and self-reported depression (vs SBFT, P=.02). All 3 treatments showed significant and similar reductions in suicidality and functional impairment. Parents' views of the credibility of cognitive behavior therapy improved compared with parents' views of both SBFT (P=.01) and NST (P=.05).

Conclusion
Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical settings, resulting in more rapid and complete treatment response.

Author Affiliations
From the Western Psychiatric Institute and Clinic (Drs Brent, Kolko, Birmaher, and Johnson and Mss Holder, Baugher, and Roth) and the Department of Statistics, University of Pittsburgh (Dr Iyengar), Pittsburgh, Pa.

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