Stories and Grievances: Special Education
Cognitive-Behavioral Therapy May Be Just As Effective As Antidepressants For Some Depressed Teenagers
Cognitive-behavioral therapy is a structured therapy that teaches problem-solving and corrects negative thought patterns, and your school psychologists may not know anything about this form of intervention.
For some depressed kids, therapy may rival pills
Study hints at link to family affluence
By Marilyn Elias
ATLANTA - Cognitive-behavioral therapy may be just as effective as antidepressants for depressed teenagers in more affluent families, a government scientist reported Thursday.
But children with severe depression, regardless of family income, appear to need the medication to recover, said Benedetto Vitiello, chief of the child and adolescent psychiatry branch at the National Institute of Mental Health (NIMH).
The issue of pills vs. therapy has taken on added urgency since the Food and Drug Administration ordered "black box labels" - the strongest warning possible - put on antidepressants last October. Those labels say the pills can increase suicidal behavior in children.
Vitiello released a new, more detailed breakout on an NIMH-funded study of 439 depressed adolescents published last year. For the first time, researchers had tested the effectiveness of Prozac compared with cognitive-behavioral therapy, a combination of pills and counseling, or placebos.
Cognitive-behavioral therapy is a structured therapy that teaches problem-solving and corrects negative thought patterns.
Overall, the combination worked best for kids, and pills beat out placebos. But placebos worked just as well as therapy for the overall group, the study showed. Teasing out how subgroups of kids fared has produced "suggestive but not conclusive" information about treating kids, Vitiello said at the American Psychiatric Association meeting here.
The new results show the younger the children, the more likely they were to improve on any treatment. Race and sex made no difference as to what treatment worked.
The findings on more affluent kids - those with family incomes of $75,000 or more - doing well in therapy "are tantalizing," Vitiello says. A family's higher income may indicate more education or other factors that may make the kids more receptive to therapy. "Still, we're not ready to give any recommendations yet," he says. The outcomes will need to be confirmed by larger studies, he adds.
Affluent parents might bring children in for treatment sooner, before symptoms become severe, and that may give them a better shot at improving with therapy alone, says Burlington, Vt., child psychiatrist David Fassler.
"The challenge is to find out what's going on in these families to make cognitive-behavioral therapy more effective, so we can use it to help all families," he says. "Still, every treatment plan needs to be tailored to the individual child."
Parents should be cautious and vigilant with depressed teens, says child psychiatrist Harold Koplewicz, director of the New York University Child Study Center. "It's not just any 'supportive' therapy that works, it's cognitive-behavioral therapy. ... Also, it's a very slippery slope from moderate to severe depression. Kids need to be watched carefully."
Cognitive-Behavioral Therapy (CBT): The Basics
National Association of Cognitive-Behavioral Therapists
The American Institute For Cognitive Therapy
The Anxiety Network International
ABOUT: Cognitive-Behavioral Therapy For Anxiety Disorders
The Attributes Of Psychotherapy For Depression
Cognitive Therapy For Depression