Psychotherapy Alone First Line of Treatment for Depressed Youth

Cognitive behavioral therapy (CBT) should be the first line of treatment in younger patients with major depressive disorder before clinicians prescribe medication, according to a study published online in The Lancet Psychiatry.

In a randomized, double-blind, placebo-controlled multicenter clinical trial, Christopher G. Davey, M.B.B.S., Ph.D., of Orygen, the National Centre of Excellence in Youth Mental Health, in Melbourne, Australia, and colleagues examined whether CBT and medication, specifically fluoxetine, were more effective for reducing depressive symptoms than CBT and placebo. The 153 participants had moderate-to-severe major depressive disorder and were aged 15 to 25 years.

The researchers found that after 12 weeks of treatment, both groups showed a reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) scores (−13.7 [95 percent confidence interval (CI), −16.0 to −11.4] in the CBT and placebo group; −15.1 [95 percent CI, −17.4 to −12.9] in the CBT and fluoxetine group). The authors observed no significant difference between the two groups in their MADRS scores (−1.4; 95 percent CI, −4.7 to 1.8; P = 0.39). There were five suicide attempts in the CBT and placebo group and one attempt in the CBT and fluoxetine group (odds ratio, 0.2; 95 percent CI, 0.0 to 1.8; P = 0.21). There were no significant findings between either group in regards to other suicidal behaviors.

"We did not find evidence that the addition of fluoxetine (rather than placebo) to CBT further reduced depressive symptoms in young people with moderate-to-severe major depressive disorder," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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