Primary research of treatments for adolescents with persistent depression
News release from the National Coordinating Centre for Health Technology Assessment
12 September 2008
Research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme has added to the evidence base on treatment for adolescents who are clinically depressed. The researchers found that for adolescents with moderate to severe major depression, the addition of cognitive behavioural therapy (CBT) to drug therapy and active clinical care did not improve patients' wellbeing enough for the CBT treatment to be cost-effective.
Depression is a major public health concern and there is emerging evidence to suggest that adolescent brain functioning may have an influence on later development. It is characterised by loss of interest in usual activities and diminished ability to experience pleasure. To avoid recurrence of a patient's depressive state and lessen vulnerability to suicidal tendencies it is important that treatment offers optimum recovery to help them continue into adulthood. Mild to moderate depression is a common disorder, however, the trial mainly focused on the minority of adolescents who suffered from moderate to severe major depression.
The research team led by Professor Ian Goodyer, of the University of Cambridge and the late Professor Dick Harrington, of the University of Manchester compared the clinical and cost-effectiveness of two treatments for depression. One treatment involved a combination of CBT with antidepressant medication. The second treatment was antidepressant drugs alone, however, both sets of patients continued to receive routine active clinical care. Over 200 adolescent patients with depressive illness were recruited and were regularly monitored for both adverse and beneficial results.
From the findings the researchers concluded that for adolescents in routine specialist clinic care with moderate to severe depression the addition of cognitive behaviour therapy to treatment with antidepressants had no benefit over treatment with antidepressants alone. However antidepressant treatment (mostly fluoxetine) is not likely to result in adverse side effects. Two thirds of the patients in both groups were no longer clinically depressed six months after they entered treatment.
Professor Goodyer commented saying, “The main objective of our research was to test whether the additional costs of CBT are offset by improvements in the patients' quality of life, therefore minimising the impact on other NHS services over a long term period. Monitoring adolescents and their families helped us to assess both the severity and improvement levels of each case to obtain a clearer picture of which treatments are the most clinically and cost-effective. This should help to inform future use of NHS resources.”
The research has published in Health Technol Assess 2008; 12:14. To view and download full report visit www.hta.ac.uk/1123
Notes for editors
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The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with more than 400 issues published to date. The journal’s 2007 Impact Factor (3.87) ranked it in the top 10 per cent of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.
- The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
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