Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder

BMJ 1998;316:1559-1563 ( 23 May )

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Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder

Richard Harrington, professor, ^a Jane Whittaker, tutor, ^a Philip Shoebridge, research worker, ^a Fiona Campbell, medical statistician. ^b

^a Department of Child and Adolescent Psychiatry, Royal Manchester Children's Hospital, Manchester M27 1HA, ^b Research and Development Support Unit, Hope Hospital, Salford, Manchester M6 8HD

Correspondence to: Professor Harrington R.C.Harrington{at}man.ac.uk

Objective: To determine whether cognitive behaviour therapy is an effective treatment for childhood and adolescentdepressive disorder.
Design: Systematic review of six randomised trials comparing the efficacy of cognitive behaviour therapy with inactiveinterventions in subjects aged 8 to 19 years with depressive disorder.
Main outcome measure: Remission from depressive disorder.
Results: The rate of remission from depressive disorder was higher in the therapy group (129/208; 62%) than in thecomparison group (61/168; 36%). The pooled odds ratio was 3.2(95% confidence interval 1.9 to 5.2), suggesting a significantbenefit of active treatment. Most studies, however, were basedon relatively mild cases of depression and were of only moderatequality.
Conclusions: Cognitive behaviour therapy may be of benefit for depressive disorder of moderate severity in childrenand adolescents. It cannot, however, yet be recommended for severedepression. Definitive large trials will be required to determinewhether the results of this systematic review are reliable.

Key messages

Depressive disorders are a common problem in child psychiatric clinics, but a recent systematic review found that tricyclic medication was of unproved benefit
This systematic review identified six randomised trials of a psychological treatment $---$ cognitive behaviour therapy $---$ in subjects aged 8 to 19 years with depressive disorder
The results seemed to show that cognitive behaviour therapy is an effective treatment for depressive disorder of moderate severity
Because of the small number of trials available for this quantitative analysis definitive large trials will be required to determine whether the present results are reliable

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Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial: Ian Goodyer, Bernadka Dubicka, Paul Wilkinson, Raphael Kelvin, Chris Roberts, Sarah Byford, Siobhan Breen, Claire Ford, Barbara Barrett, Alison Leech, Justine Rothwell, Lydia White, and Richard Harrington
BMJ 2007 335: 142. [Abstract] [Full Text] [PDF]

Cognitive behaviour therapy is promising in childhood depressive disorder
BMJ 1998 316: 0. [Full Text]

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