section name header

Evidence summaries

Psychological Therapies Versus Antidepressant Medication for Depression in Children and Adolescents

There is insufficient evidence to assess the comparative effectiveness of antidepressive medication, psychological therapies, or a combination of these interventions in the treatment of major depressive disorder in children and adolescents. Antidepressive medication alone may be associated with more suicidal ideations than psychological treatments alone. Level of evidence: "D"

Comment: The quality of evidence is downgraded by study limitations (lack of blinding, imbalance in baseline risk), imprecise results (few patients, wide confidence intervals).

Summary

A Cochrane review [Abstract] 1 included 10 studies, involving 1235 patients (children and adolescents) with major depressive disorder. Studies recruited participants with different severities of disorders and with a variety of comorbidities, including anxiety and substance use disorder. Most commonly studied psychotherapies were cognitive behavioural therapy, interpersonal psychotherapy and psychodynamic therapy.

The relative effectiveness of psychological interventions, antidepressant medication and a combination of these interventions remains unclear. For the majority of outcomes there were no statistically significant differences between the interventions compared

OutcomeNumber of participants (trials)Control:Antidepressant medicationIntervention:Psychological therapiesEffect size (95 % CI)
Remission immediately post-intervention220(2)68%54%OR 0.62(0.28 to 1.35)
Suicidal ideation immediately post-intervention188(1)19%5%OR 0.26(0.09 to 0.72)
Suicidal ideation at 6 to 9 months149(1)14%4%OR 0.26(0.07 to 0.98)
Number of participants (trials)Control:Antidepressant medication Intervention:Psychological therapies combined to antidepressant medicationOutcome
Remission immediately post-intervention378(3)58%66%OR 1.56(0.98 to 2.47)

Clinical comments

Note

Date of latest search: 2011-11-28

References

  • Cox GR, Callahan P, Churchill R et al. Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane Database Syst Rev 2012;11():CD008324. [PubMed]

Primary/Secondary Keywords