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CBT for Preventing Depression in Teens? It Depends

CBT showed no preventive effects in adolescents whose parents were currently depressed.

Major depressive disorder (MDD) in adolescence is associated with relatively poor response and high recurrence rates, and the adverse effects of antidepressants are well known. Preventing the disorder with nondrug tools would be clinically useful.

In this multisite study, the 316 at-risk participants (age range, 13–17) had a parent with past or present MDD and had previous MDD or current subsyndromal symptoms. They were randomized to group cognitive-behavioral therapy or usual care. CBT involved eight weekly and then six monthly 90-minute sessions; the mixed-sex groups consisted of 3 to 10 teenagers.

Mean attendance was 6.5 sessions during the first 8 weeks (range, 0–8) and 3.8 sessions during the last 6 months. A baseline informational meeting was attended by 76% of parents. Overall, incident MDD was significantly lower with CBT than with usual care. Group outcomes did not differ among teens with a currently depressed parent (CBT, 31%; usual care, 24%), but were significantly better with CBT among teens whose parents did not currently have MDD (incident MDD: 12% vs. 41% with usual care).

Comment: Implementing group CBT in the community involved several logistical challenges (e.g., training the therapists, arranging meeting times for the groups). More analyses would have been useful. For example, further examination of teenagers’ attendance might have indicated whether a less-elaborate intervention would be effective. Analyses of the effects of group size, sex ratio, and parental attendance at informational sessions would have been relevant. Earlier research linked parental MDD to depression in offspring, consistent with this study’s finding that CBT did not prevent adolescent depression when parents had MDD. Evaluating and treating parental depression are of high clinical importance.

— Barbara Geller, MD

Published in Journal Watch Psychiatry June 2, 2009

Citation(s):

Garber J et al. Prevention of depression in at-risk adolescents: A randomized controlled trial. JAMA 2009 Jun 3; 301:2215.

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Reader Remarks:

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• Does this suggest universal preventive intervention is preferred to indicated prevention?
  Robert W Anthony, Adolescent Wellness, Inc., 23 Jul 2009 10:54 AM EST
  Since 'Group outcomes ... were significantly better with CBT among teens whose parents did not currently have MDD (incident MDD:... [more]
• Universal vs. Indicated Prevention
  Barbara Geller, MD, Emeritus Professor, Washington University in St. Louis; Journal Watch Psychiatry Associate Editor, 29 Jul 2009 3:19 PM EST
  You have raised a very excellent question about what this work means clinically. Some might infer that using preventive measures... [more]