CoChat
Sign Up
Cited by 70Treatment of Major DepressionChild and Adolescent Psychosocial and Emotional DevelopmentPsychotherapy Techniques and Applications

Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents

Open access
Cox, Georgina R, Callahan, Patch, Churchill, Rachel, Hunot, Vivien, Merry, Sally N, Parker, Alexandra G, Hetrick, Sarah E·2012·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd008324.pub2
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Depressive disorders are common in children and adolescents and, if left untreated, are likely to recur in adulthood. Depression is highly debilitating, affecting psychosocial, family and academic functioning. OBJECTIVES: To evaluate the effectiveness of psychological therapies and antidepressant medication, alone and in combination, for the treatment of depressive disorder in children and adolescents. We have examined clinical outcomes including remission, clinician and self reported depression measures, and suicide-related outcomes. SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to 11 November 2011. This register contains reports of relevant randomised controlled trials (RCTs) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). SELECTION CRITERIA: RCTs were eligible for inclusion if they compared i) any psychological therapy with any antidepressant medication, or ii) a combination of psychological therapy and antidepressant medication with a psychological therapy alone, or an antidepressant medication alone, or iii) a combination of psychological therapy and antidepressant medication with a placebo or 'treatment as usual', or (iv) a combination of psychological therapy and antidepressant medication with a psychological therapy or antidepressant medication plus a placebo.We included studies if they involved participants aged between 6 and 18 years, diagnosed by a clinician as having Major Depressive Disorder (MDD) based on Diagnostic and Statistical Manual (DSM) or International Classification of Diseases (ICD) criteria. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed the quality of the studies. We applied a random-effects meta-analysis, using the odds ratio (OR) to describe dichotomous outcomes, mean difference (MD) to describe continuous outcomes when the same measures were used, and standard mean difference (SMD) when outcomes were measured on different scales. MAIN RESULTS: We included ten studies, involving 1235 participants in this review. Studies recruited participants with different severities of disorder and with a variety of comorbid disorders, including anxiety and substance use disorder, therefore limiting the comparability of the results. Regarding the risk of bias in studies, half the studies had adequate allocation concealment (there was insufficient information to determine allocation concealment in the remainder), outcome assessors were blind to the participants' intervention in six studies, and in general, studies reported on incomplete data analysis methods, mainly using intention-to-treat (ITT) analyses. For the majority of outcomes there were no statistically significant differences between the interventions compared. There was limited evidence (based on two studies involving 220 participants) that antidepressant medication was more effective than psychotherapy on measures of clinician defined remission immediately post-intervention (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.27 to 0.98), with 67.8% of participants in the medication group and 53.7% in the psychotherapy group rated as being in remission. There was limited evidence (based on three studies involving 378 participants) that combination therapy was more effective than antidepressant medication alone in achieving higher remission from a depressive episode immediately post-intervention (OR 1.56, 95% CI 0.98 to 2.47), with 65.9% of participants treated with combination therapy and 57.8% of participants treated with medication, rated as being in remission. There was no evidence to suggest that combination therapy was more effective than psychological therapy alone, based on clinician rated remission immediately post-intervention (OR 1.82, 95% CI 0.38 to 8.68).Suicide-related Serious Adverse Events (SAEs) were reported in various ways across studies and could not be combined in meta-analyses. However suicidal ideation specifically was generally measured and reported using standardised assessment tools suitable for meta-analysis. In one study involving 188 participants, rates of suicidal ideation were significantly higher in the antidepressant medication group (18.6%) compared with the psychological therapy group (5.4%) (OR 0.26, 95% CI 0.09 to 0.72) and this effect appeared to remain at six to nine months (OR 1.27, 95% CI 0.68 to 2.36), with 13.6% of participants in the medication group and 3.9% of participants in the psychological therapy group reporting suicidal ideation. It was unclear what the effect of combination therapy was compared with either antidepressant medication alone or psychological therapy alone on rates of suicidal ideation. The impact of any of the assigned treatment packages on drop out was also mostly unclear across the various comparisons in the review.Limited dat

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1002/14651858.cd008324.pub2

Cites

126 of 126 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 15

  1. cognitive-behaviour therapy versus fluoxetine alone in adolescents with major depression (ADAPT Trial) [conference abstract]. In: Proceedings of the 30th Annual Conference of the British Association for Behavioural and Cognitive Psychotherapies; 2002 Jul 17-20;
  2. Deas D, Randall CL, Roberts JS, Anton RF. A double-blind, placebo-controlled trial of sertraline in depressed adolescent alcoholics: a pilot study. Human Psychopharmacology 2000;15:461-9.
  3. March J, Silva S, Curry J, Wells K, Fairbank J, Burns B, et al. The Treatment for Adolescents With Depression Study (TADS): outcomes over 1 year of naturalistic follow-up. American Journal of Psychiatry 2009;166(10):1141-9.
  4. * Treatment for Adolescents With Depression Study Team. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. JAMA 2004;292(7):807-820. TASA 2009 [ ClinicalTrials.gov: NCT00080158]
  5. Dujovne VF. Comparison of cognitive-behavioral to pharmacological treatment of depression in prepubertal children. Dissertation Abstracts International 1994;54(10-B):5384.
  6. APA 1994 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV). 4th edition. Washington, DC: American Psychiatric Association, 1994. APA 2000 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th edition. Washington, DC: American Psychiatric Association, 2000.
  7. Beck 1979a Beck AT, Kovacs M, Weissman A. Assessment of suicidal ideation: The Scale for Suicidal Ideation. Journal of Consulting and Clinical Psychology 1979;47(2):343-52.
  8. Brent DA, Emslie GJ, Clarke GN, Asarnow J, Spirito A, Ritz L, et al. Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study. American Journal of Psychiatry 2009;166(4):418-26.
  9. Cheung 2008a Cheung AH, Zuckerbrot RA, Jensen PS, Ghalib K, Laraque D, Stein REK. Guidelines for adolescent depression in primary care (GLAD-PC): II treatment and ongoing management. Pediatrics 2008;121(1):227.
  10. Clarke GN, Lewisohn PM, Hops H, Seeley J. A self-and parent-report measure of adolescent depression: the Child Behaviour Checklist Depression Scale (CBCL-D). Behavioural Assessment 1992;14:443-63.
  11. Harrington R, Dubicka B, Leech A, et al. Randomised controlled trial of fluoxetine and cognitive-behaviour therapy versus fluoxetine alone in adolescents with major depression (ADAPT Trial). In: Proceedings of the 30th Annual Conference of the British Association for Behavioural and Cognitive Psychotherapies; 2002 July 17-20, Warwick, UK. 2002.
  12. Review Manager (RevMan) [Computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
  13. Wood A, Kroll L, Moore A, Harrington RC. Properties of the mood and feelings questionnaire: a research note. Journal of Child and Adolescent Psychology and Psychiatry 1995;36:298-302.
  14. placebo$.mp. 72. MetaAnalysis/ 73. (meta-analy$ or metaanaly$ or meta analy$).tw. 30. review.pt. 31. systematic review$.tw. 32. or/27-31 33. 20 and 26 34. 20 and 32 35. 33 or 34 38. primary control.tw. 39. secondary control.tw. 40. non-pharmacological.tw. 41. or/4-40 42. exp Antidepressant Agent/ 43. exp Monoamine Oxidase Inhibitor/ 44. exp Noradrenalin Uptake Inhibitor/ 45. exp Serotonin Uptake Inhibitor/ 46. exp Tetracyclic Antidepressant Agent/ 47. exp Tricyclic Antidepressant Agent/ 48. or/42-47 49. 3 and 41 and 48 50. Adult Children/ 51. Minors/ 52. Homeless Youth/ 53. (juvenile$ or underage$ or teen$ or youth$ or pubescen$ or adolescen$).tw.
  15. Cox, G. R., Callahan, P., Churchill, R., Hunot, V., Merry, S. N., Parker, A. G. & Hetrick, S. E. (2012). Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents.. Cochrane Database Syst Rev, 11 (11), pp.CD008324-. https://doi.org/10.1002/14651858.CD008324.pub2. Persistent Link: http://hdl.handle.net/11343/59254 File Description: Published version

Cited by

Sorted by citations

Related

Authors
Cox, G. R., Callahan, P., Churchill, R., Hunot, V., Merry, S. N., Parker, A. G., & Hetrick, S. E.
Affiliations
  • The University of Melbourne (AU)
  • University of Bristol (GB)
  • University of Auckland (NZ)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2012-11-14
Volume
11
Pages
CD008324-CD008324
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd008324.pub2
OpenAlex
W4233970959
Cited by
70
References
124
Citations by year
2026: 3 · 2025: 3 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 5 · 2018: 6 · 2017: 3 · 2016: 5 · 2015: 14 · 2014: 10 · 2013: 7 · 2012: 1
Type
reference entry
Language
en
Update notices
new_version (2014-11-30)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
  • ResearchSpace (University of Auckland) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
child and adolescent depression, major depressive disorder, psychotherapy, antidepressants, combination therapy, treatment remission, suicide risk, relapse, anxiety comorbidity, substance use disorders, risk of bias, allocation concealment, outcome assessment bias, intention-to-treat analysis
MeSH terms
Adolescent, Antidepressive Agents, Anxiety, Child, Combined Modality Therapy, Depression, Humans, Psychotherapy, Randomized Controlled Trials as Topic, Substance-Related Disorders, Suicidal Ideation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review