Combined treatment with cognitive-behavioural therapy in adolescent depression: Meta-analysis

Background: The treatment of adolescent depression is controversial and studies of combined treatment (antidepressants and cognitive-behavioural therapy, CBT) have produced conflicting findings. Aims: To address the question of whether CBT confers additional benefit to antidepressant treatment in adolescents with unipolar depression for depressive symptoms, suicidality, impairment and global improvement. Method: Meta-analysis of randomised controlled trials (RCTs) of newer-generation antidepressants and CBT in adolescent depression. Results: There was no evidence of a statistically significant benefit of combined treatment over antidepressants for depressive symptoms, suicidality and global improvement after acute treatment or at follow-up. There was a statistically significant advantage of combined treatment for impairment in the short-term (at 12 weeks) only. There was some evidence of heterogeneity between studies. Conclusions: Adding CBT to antidepressants confers limited advantage for the treatment of an episode of depression in adolescents. The variation in sampling and methodology between studies, as well as the small number of trials, limits the generalisability of the findings and any conclusions that can be drawn. Future studies should examine predictors of response to treatment as well as clinical components that may affect outcome.