Adding CBT to antidepressant treatment not cost-effective for adolescent depression

Research published by Britain's National Institute for Health Research Health Technology Assessment (NIHR HTA) program has added to the evidence base on treatment for adolescents who are clinically depressed. The researchers found that for adolescents with moderate to severe major depression, the addition of cognitive behavioral therapy (CBT) to drug therapy and active clinical care did not improve patients' wellbeing enough for the CBT treatment to be cost-effective.

Depression is a major public health concern and there is emerging evidence to suggest that adolescent brain functioning may have an influence on later development. It is characterized by loss of interest in usual activities and diminished ability to experience pleasure. To avoid recurrence of a patient's depressive state and lessen vulnerability to suicidal tendencies it is important that treatment offers optimum recovery to help them continue into adulthood. Mild to moderate depression is a common disorder, however, the trial mainly focused on the minority of adolescents who suffered from moderate to severe major depression.

The research team led by Professor Ian Goodyer, of the University of Cambridge and the late Professor Dick Harrington, of the University of Manchester compared the clinical and cost-effectiveness of two treatments for depression. One treatment involved a combination of CBT with antidepressant medication. The second treatment was antidepressant drugs alone, however, both sets of patients continued to receive routine active clinical care. Over 200 adolescent patients with depressive illness were recruited and were regularly monitored for both adverse and beneficial results.

From the findings the researchers concluded that for adolescents in routine specialist clinic care with moderate to severe depression the addition of cognitive behavior therapy to treatment with antidepressants had no benefit over treatment with antidepressants alone. However antidepressant treatment, mainly fluoxetine (Prozac^®), is not likely to result in adverse side effects. Two thirds of the patients in both groups were no longer clinically depressed six months after they entered treatment.

Professor Goodyer commented saying, "The main objective of our research was to test whether the additional costs of CBT are offset by improvements in the patients' quality of life, therefore minimizing the impact on other NHS services over a long term period. Monitoring adolescents and their families helped us to assess both the severity and improvement levels of each case to obtain a clearer picture of which treatments are the most clinically and cost-effective. This should help to inform future use of NHS resources."

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Goodyer IM, Dubicka B, Wilkinson P, et al. A randomised controlled trial of cognitive behaviour therapy in adolescents with major depression treated by selective serotonin reuptake inhibitors. The ADAPT trial.   [Abstract | Full text ()]