Harvard Mental Health Letter

In Brief: Cognitive behavioral therapy improves outcomes in depressed adolescents

In Brief

Cognitive behavioral therapy improves outcomes in depressed adolescents

Antidepressants now carry warnings that the drugs may increase the risk of suicidal thinking and behavior in patients ages 18 and under, making physicians reluctant to prescribe them for this age group and generating an ongoing and sometimes bitter debate. One of the most comprehensive studies done to date suggests that one way to reduce suicide risk in depressed adolescents who are taking antidepressants is to combine drug therapy with cognitive behavioral therapy (CBT), which teaches patients to recognize and overcome ingrained patterns of negative thoughts and behaviors.

The Treatment for Adolescents with Depression Study enrolled 327 patients ages 12 to 17 diagnosed with major depression and randomly assigned them to treatment with fluoxetine (Prozac), CBT, or both. Researchers then evaluated treatment response and suicidal ideation or behavior at weeks 12 and 36, to assess short- and long-term effectiveness.

At week 12, drug therapy alone was more effective than CBT alone, although the combination worked best: 62% of patients responded positively to drug treatment alone, 48% to CBT alone, and 73% to combination therapy. At week 36, drug treatment and CBT were equally effective, but combination treatment was still the most effective: 81% of patients were responding to either drug therapy or CBT alone, while 86% were responding to combination treatment.

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