Common Mental Disorders Depression - New Zealand Doctor

Exercise
There was insufficient evidence to determine whether exercise is effective for the
treatment of depression in young people.
Psychological therapies
Primary care studies: review of data
The NICE (2005) 66 guideline and a subsequent systematic review 267 considered RCTs
of psychological therapies for young people and included studies from a variety of
educational, correctional, psychiatric, research and unreported settings. Only one
small RCT was clearly applicable to primary care. 268 This study found 12 sessions of
IPT significantly more effective than treatment as usual at 16-week follow-up among
64 adolescents at a school-based mental health clinic in the US. The intervention
focussed on problem solving and social functioning. Most adolescents in the treatment
as usual arm received a form of supportive counselling and the additional use of
antidepressants was an option in both arms. The largest treatment effects occurred in
the older and/or more severely depressed adolescents.
Two more recently published primary care-based RCTs were identified: one from
the US and one from Australia. The US RCT 269 enrolled 152 moderately depressed
adolescents, all receiving a newly-prescribed selective serotonin reuptake inhibitor
(SSRI), and randomised one group to brief CBT treatment (5–9, 1-hour sessions).
Greater improvement in depression scores was seen in the group receiving CBT, but
the difference in scores between the two groups was not statistically significant. The
Australian RCT 270 was a three-way comparison between sertraline, CBT, and combined
therapy in 73 adolescents. This trial found CBT superior to sertraline alone in the
treatment of mild to moderate depression. 270 However, 14% of the CBT group and
54% of the sertraline group had not achieved full or partial remission at post-treatment
follow-up (12 weeks). The authors commented that the dosage of sertraline used
(maximum of 100 mg daily) was relatively low compared to some studies. At 9-month
follow-up, improvements from the baseline were maintained in all groups, with no
significant difference between the groups. No significant advantage was found from
combined therapy at either post-treatment or 9-month follow-up.
Studies conducted in secondary care or other settings:
review of data
A well-known US RCT, 271 the Treatment for Adolescents with Depression Study (TADS),
claims to be broadly applicable to general clinical practice. However, more than half the
participants were volunteers and the mean level of severity of depression was moderate
to severe.
The Treatment for Adolescents with Depression Study found that treatment with CBT
alone was not significantly more effective than placebo. Combined therapy with
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Identification of Common Mental Disorders and Management of Depression in Primary Care