Psychotherapy May Offer Fewer Benefits in Depressed Children

(In paragraph 2, corrects to 300, from 800)

March 23, 2020

By Linda Carroll

(Reuters Health) - Depressed children and teens may benefit less from psychotherapy than adults do, a new study suggests.

Pooled data from more than 300 previous studies suggests psychotherapy helps young adults the most, children and teens the least, ressearchers report in JAMA Psychiatry.

"The take home message is that psychotherapies do not work as (well) in children and adolescents as in adults," said Pim Cuijpers, a professor of clinical psychology at Vrije Universiteit Amsterdam, who led the study.

"Psychotherapies are still very important and effective in children and adolescents, but they work better in adults," Cuijpers said in an email. "They also work well in older adults, including those above 75."

That doesn't mean these types of therapies should not be used in youngsters, Cuijpers said.

"Psychotherapies are still the best option for the treatment for depression in children and adolescents," he added. "Medication should be avoided when possible, because the effects are also very small and suicidality may be an important side effect. So the effects of the therapy may be modest but it is still the best option."

To take a closer look at the efficacy of psychotherapy for depression in various age groups, Cuijpers and his colleagues searched the literature for trials comparing psychotherapy with control conditions through January 2019. They found 2,608 full-text articles and included 366 studies in their analysis. These included 36,702 patients, of whom 19,544 received treatment and 17,158 served as controls.

Overall, the effect sizes for psychotherapy were smaller in children and teens than in adults. Effect sizes of treatment were also significantly larger in young adults than in middle-aged and older adults.

Cuijpers and his colleagues cautioned against reading too much into the study findings.

"The outcomes should be considered with caution because of the suboptimal quality of most of the studies and the high levels of heterogeneity," they write. "However, most primary findings proved robust across sensitivity analyses, addressing risk of bias, target populations included, type of therapy, diagnosis of mood disorder, and method of data analysis."

The study findings didn't surprise Kathryn Van Eck, an assistant professor in the department of psychiatry in the division of child and adolescent psychiatry at Johns Hopkins University in Baltimore.

Children are different from adults in that they are embedded in a family unit, Van Eck said. "And environment plays an enormous role in depression," she added. "The relationship with the family and its structure can be a very important driver of symptoms. Adults have much more control over their lives."

Parent management training can help with family issues, Van Eck said. "Even small changes in creating routines and stability and consistency can really help a child so much," she added.

The findings on the oldest patients were hopeful, Van Eck said. "The effects for older old adults were pretty substantial," she said. "That to me is very important, especially as we see the baby boom generation moving into that age range."

Having effective treatments for depression in older old adults may help preserve cognition, Van Eck said. "Depression is really linked to cognitive impairments," she explained. "If people in that age range can stay mentally healthy it might help preserve cognitive health. That's really exciting."

SOURCE: and JAMA Psychiatry, online March 18, 2020.