A systematic review that included six randomized studies, compared the effect of cognitive behaviour therapy (CBT) to that of inactive intervention in 8-19-year-old depressed patients 1. In the therapy group remission was achieved in 129/208 patients (68%), in the control group in 61/168 patients (36%). Pooled odds ratio was 3.2 (95% CI 1.9-5.2) and NNT was 3.6, i.e. active treatment was efficient. In most of the studies the depression of study subjects was rather mild and the quality of the studies was mediocre.
Another systematic review 2 including 7 studies with a total of 295 subjects was abstracted in DARE. There were no RCTs. The effect size at post-test ranged from 0.41 to 1.70). Effect size at follow-up ranged from 0.60 to 1.69. Using Cohen´s cutoff criteria results suggest that intervention groups improved more than control.
A third systematic review 3 including 7 RCTs and 2 controlled studies on cognitive-behavioural therapy in children with depressive symptoms, 6 RCTs on cognitive-behavioural therapy for children diagnosed with a depressive disorder and 4 RCTs on family therapy in childhood depression was abstracted in DARE. 4 RCTs investigated the prevention of relapse and 5 RCTs looked at interventions to prevent depression in children. Cognitive-behavioural therapy was superior to no treatment in depressive symptoms. For children with a diagnosed depressive disorder, cognitive-behavioural therapy was superior to comparison interventions (OR 2.2, NNT = 4). Comparative studies on family interventions did not find a significant difference from comparison interventions. Only one out of four RCTs found a significant long-term effect of treatment.
A fourth systematic review 4 including 6 studies with a total of 251 subjects was abstracted in DARE. The six studies included 14 posttreatment control comparisons and 10 follow-up control comparisons. The overall effect size of the posttreatment difference in scores was -1.02, 95% CI -0.81 to -1.23, and the effect size for follow-up difference in scores was -0.61, 95% CI -0.35 to -0.88 indicating that the effects of CBT were maintained over time.
In a randomized controlled multi-centre trial 5 a volunteer sample of 439 patients (age range 12 to 17 years) with major depressive disorder received either fluoxetine alone (10 to 40 mg/d); CBT alone; CBT with fluoxetine (10 to 40 mg/d); or placebo (equivalent to 10 to 40 mg/d) for 12 weeks. Rates of response for fluoxetine with CBT were 71.0% (95% CI 62%-80%); fluoxetine alone 60.6% (95% CI 51%-70%); CBT alone 43.2% (95% CI 34%-52%); and placebo, 34.8% (95% CI 26%-44%). Compared with placebo, the combination of fluoxetine with CBT was statistically significant (P =0.001) on the Children's Depression Rating Scale-Revised. Compared with fluoxetine alone (P =0.02) and CBT alone (P =0.01), treatment of fluoxetine with CBT was superior. Fluoxetine alone is a superior treatment to CBT alone (P =0.01). On the Clinical Global Impressions improvement responder analysis, the 2 fluoxetine-containing conditions were statistically superior to CBT and to placebo.
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