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 “We have already shown that the intervention was more effective than
usual care but it is surprising that we are still finding a
difference between groups six years later,” said lead author Dr.
David A. Brent of the University of Pittsburgh Medical Center.
Over time, youngsters in the therapy group were still at risk for
depression but were functioning better at work and in their
interpersonal lives as a result of having more depression free days,
Brent told Reuters Health by email.
The researchers randomly divided 316 at-risk teens, with prior
depressive episodes of their own and with at least one parent having
current or prior depressive episodes, into two groups between 2003
and 2006.
Teens in the cognitive-behavioral prevention program attended eight
weekly 90-minute group therapy sessions followed by six months of
monthly sessions. The other group did not receive care other than
what might have been initiated by their family members.
Some teens in each group did develop depression during the study
period and over the six-year follow up period, but it was less
common in the therapy group, the authors reported in JAMA
Psychiatry.
Over the first nine months of the study, those in the therapy group
were about 36 percent less likely to develop depression than those
in the comparison group.
“Even six years after the intervention,” the risk of depression was
lower for adolescents who received cognitive-behavioral prevention
therapy than for those who received usual care, the authors
reported.
“This preventive effect largely was driven by the significant
difference in new onsets of depression during the first nine months
after enrollment,” they added, because after that point, the risk of
new depressive episodes was similar in the two groups.
The therapy was most effective for kids whose parents were not
depressed when the study began, the authors noted.
“Theoretically, cognitive behavioral therapy works by changing
children's thinking patterns - so that they can challenge negative
thoughts and not engage in the kinds of interpretations of events in
their lives that lead to depression,” said Irwin Sandler, director
of the Prevention Research Center at Arizona State University in
Tempe, who was not part of the new study.
The best time to begin this preventive therapy may be following a
parent’s treatment for depression rather than during treatment,
Sandler told Reuters Health by email.
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Teens are actively learning new academic and social skills, and a
person who is depressed most likely will fall behind his or her
peers, he said.
“By relieving that depression, he or she will catch up to some
degree and that could be reflected years later,” he said.
“Youth who have had a previous episode of depression should receive
some ongoing help to keep them well, this is now standard care,” he
said. “Youth who are at risk, and may have some symptoms but not
full blown depression would probably benefit from getting
(cognitive-behavioral therapy) earlier, prior to developing a
full-blown episode.”
If a child appears to develop depressive symptoms, earlier
intervention is better, he said.
Group therapy sessions cost considerably less than individual
sessions, said Jeremy Pettit, professor of Psychology and Psychiatry
at Florida International University in Miami, who was not part of
the new study.
“Even adolescents who do not respond well to this kind of program in
terms of depression prevention tend to report that they benefited in
some ways from the program and that they are satisfied with the
program,” Pettit told Reuters Health by email.
“Prevention services are not widely available because our health
system does not reimburse for them, so it's a real problem, Sandler
said. Some programs are offered through schools or other community
agencies, he said.
Not everything offered as prevention really is evidence based, so
parents need to do their homework and insist on programs that have
been demonstrated to work and where the leaders are certified to be
competent providers of the program, Sandler said.
SOURCE: http://bit.ly/1FSzkJu JAMA Psychiatry, September 30, 2015.
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