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Because adolescent depression is associated with high rates of recurrence and suicidality, preventive strategies are useful (JAMA 1999; 281:1707). These investigators randomized 316 adolescents (age range, 13–17) at high risk for depression to usual care alone or usual care plus cognitive-behavioral therapy adapted for prevention (CBT-P). At baseline, participants were depression-free, with either current subsyndromal symptoms or a past episode, and had a parent with current depression, current dysthymia, or a past history of recurrent or chronic depression. CBT-P involved eight 90-minute sessions with six monthly follow-ups.
At 6-year follow-up, the two groups showed no significant difference in the percentage of participants with depressive episodes (CBT-P, 62%; usual care only, 71%). For participants without a baseline depressed parent, CBT-P was associated with significantly fewer depressive episodes (53% vs. 71% for usual care only) and with better scores on a questionnaire measuring academic and social functioning. Among participants with a baseline depressed parent, the CBT-P group did not differ from the control group in the percentage with depressive episodes (71% and 70%).
Brent DA et al. Effect of a cognitive-behavioral prevention program on depression 6 years after implementation among at-risk adolescents: A randomized clinical trial. JAMA Psychiatry 2015 Sep 30; [e-pub]. (http://dx.doi.org/10.1001/jamapsychiatry.2015.1559)
Comment
These data support using CBT-P only in high-risk teenagers without a parent who had baseline depression. But even in this group, further preventive interventions are needed because most participants had depressive episodes during follow-up. For adolescents with a currently depressed parent, treatment of the depressed parent might lessen depressive symptoms in the offspring. For example, in a longitudinal study of children ages 7 to 17 years with depressed mothers, offspring whose mothers received treatment had significantly fewer depressive symptoms at follow-up (NEJM JW Psychiatry Jun 2006 and JAMA 2006; 295:1389).