Combined treatment with cognitive–behavioural therapy in adolescent depression: meta-analysis
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Background: The treatment of adolescent depression is controversial and studies of combined treatment (antidepressants and cognitive–behavioural therapy, CBT) have produced conflicting findings. Aims: To address the question of whether CBT confers additional benefit to antidepressant treatment in adolescents with unipolar depression for depressive symptoms, suicidality, impairment and global improvement. Method: Meta-analysis of randomised controlled trials (RCTs) of newer-generation antidepressants and CBT in adolescent depression. Results: There was no evidence of a statistically significant benefit of combined treatment over antidepressants for depressive symptoms, suicidality and global improvement after acute treatment or at follow-up. There was a statistically significant advantage of combined treatment for impairment in the short-term (at 12 weeks) only. There was some evidence of heterogeneity between studies. Conclusions: Adding CBT to antidepressants confers limited advantage for the treatment of an episode of depression in adolescents. The variation in sampling and methodology between studies, as well as the small number of trials, limits the generalisability of the findings and any conclusions that can be drawn. Future studies should examine predictors of response to treatment as well as clinical components that may affect outcome.
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Dubicka et al. (2010) reported self-harm occurred in 19 of 569 (3.3%) young people with depression treated with antidepressants compared to 12 in 469 of those treated with placebo.
“Dubicka et al. (2010) also reported that self-harm occurred in 19 of 569 (3.3%) young people with depression treated with antidepressants compared to 12 in 469 of those treated with a placebo (2.6%).”
From Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review with Meta-Analysis (2024) · cites this paper as Dubicka et al., 2010
The Systematic data and Suicidality sections discuss self-harm and suicidal events, but do not report the claimed counts or percentages for antidepressant-treated and placebo-treated young people. The Study characteristics section says only one included trial had a placebo arm. Searches for the counts, percentages, and placebo comparison found no passage verifying the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredDubicka et al. (2010) found the OR for antidepressant exposure was 1.70 (95% CI, 1.13-2.54).
“Dubicka et al. (2010) found the OR for antidepressant exposure was 1.70 (95% CI, 1.13–2.54).”
From Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review with Meta-Analysis (2024) · cites this paper as Dubicka et al., 2010
The Antidepressant treatment section describes drugs and doses but gives no odds ratio for antidepressant exposure. The Improvement section reports odds ratios for clinical improvement, a different outcome. Searches for 1.70 and the stated confidence interval found no matching result in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDubicka et al. (2010) found suicidal thoughts occurred in nine of 738 (1.2%) young people with depression treated with antidepressants compared to five in 634 of those treated with placebo.
“Dubicka et al. (2010) found suicidal thoughts, which occurred in nine of 738 (1.2%) young people with depression treated with antidepressants compared to five in 634 of those treated with a placebo (2.6%).”
From Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review with Meta-Analysis (2024) · cites this paper as Dubicka et al., 2010
The Systematic data and Suicidality sections discuss suicidal ideation in trials of antidepressants with or without CBT, but do not report nine of 738 antidepressant-treated young people or five of 634 placebo-treated young people. The Study characteristics section says only TADS had a placebo arm; it gives no placebo comparison with the claimed counts. Searches for the counts and percentages found no matching passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThere was a significant association between the risk of youth suicidal thoughts and antidepressant use (OR:1.45).
“The results indicated a significant association between the risk of youth suicidal thoughts and antidepressant use (OR:1.45).”
From Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review with Meta-Analysis (2024) · cites this paper as Dubicka et al., 2010
The Suicidality and Systematic data sections compare antidepressants alone with antidepressants plus CBT, not antidepressant use with non-use. Our copy reports no odds ratio of 1.45 for youth suicidal thoughts; searches for that figure and for an antidepressant-versus-placebo comparison did not find the claimed result. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThere was a significant association between the risk of youth self-harm and antidepressant use, with an OR of 1.44.
“The results represented a significant association between the risk of youth self-harm and antidepressant use, with an OR of 1.44 (Table 3).”
From Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review with Meta-Analysis (2024) · cites this paper as Dubicka et al., 2010
The Systematic data and Suicidality sections compare antidepressants alone with antidepressants plus CBT, not antidepressant use with non-use. I searched for the claimed self-harm association and OR of 1.44; neither appears in the relevant passages of our copy. (LLM, conf=0.74)
Experimental — accuracy not yet measured
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- Authors
- Dubicka, B., Elvins, R., Roberts, C., Chick, G., Wilkinson, P., & Goodyer, I. M.
- Affiliations
- University of Manchester (GB)
- Royal Manchester Children's Hospital (GB)
- University of Cambridge (GB)
- Corresponding author
- Dubicka, Bernadka
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2010-12
- Volume
- 197
- Issue
- 6
- Pages
- 433-440
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2152747725
- Cited by
- 116
- References
- 26
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 9 · 2020: 4 · 2019: 5 · 2018: 19 · 2017: 5 · 2016: 8 · 2015: 11 · 2014: 13 · 2013: 11 · 2012: 13
- FWCI
- 7.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- adolescent depression, cognitive behavioral therapy, antidepressants, combination therapy, major depressive disorder, suicidality, functional disability, depressive symptoms, treatment response
- MeSH terms
- Adolescent, Child, Combined Modality Therapy, Depressive Disorder, Female, Humans, Male, Psychiatric Status Rating Scales, Suicide, Attempted, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Practice Guidelines as Topic, Suicidal Ideation
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