Authors' objectives: Depression in adolescents is a very serious problem with over half of those diagnosed retaining their problem into young adulthood. Current best evidence based ethical treatmen involves psychosocial interventions together with an anti-depressant (fluoxetine). After 6 months only 20% show full recovery, 30% improve but are not fully recovered, a further 30% are left with a high number of residual depressive symptoms and 20% do not respond at all. The reasons for the poor responses are unclear. It is possible that theduration of psychological treatment in routine practice is often shorter then necessary, or that the treatment is not administered to a sufficiently high standard or that patients have not been followed along for long enough or that with the unselected patients one or both of the type of treatment offered is not effective. Thus many patients remain at considerable risk of relapse in the weeks and months following the cessation of treatment. Given that depression in adulthood is one of the three most important health burdens on UK society and emerging evidence suggesting that adolescent brain functioning may have formative influence for later development, finding ways to decrease the risk adolescent recurrent depressions through adequate treatment of early episodes would be a major public health advance. This investigation seeks to establish if increasing the amount and quality of psychological treatments offered in one or both of two ways will increase treatment response, reduce the level of residual symptoms and decrease the proportion of patients at risk for depressive relapse. To achieve our objectives we will compare 3 different treatments as delivered in adolescent mental health services across the UK and over a time period of 12 months , twice as long as any previous study. One of the treatments will be 'treatment as usual' (TAU=generally addressing the life situation of the adolescent and the family plus fluoxetine) the other two will also receive TAU but will also have either a brief psychodynamic psychotherapy or cognitive behaviour therapy, the treatments with strongest evidence base and most commonly offered routinely in the NHS but often inadequately or for too short a period. We do not expect that the specialist therapies on their own would effectively treat depression but we predict that, in conjunction with TAU, one or both the therapies will generate better outcomes than TAU alone over a 12 month period.

Project Status: Completed

URL for project: http://www.journalslibrary.nihr.ac.uk/programmes/hta/060501

Year Published: 2017

URL for published report: https://www.journalslibrary.nihr.ac.uk/programmes/hta/060501#/

Requestor: NIHR Health Technology Assessment programme

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

Pubmed ID: 28394249

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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