Professor Bruce Tonge
Dr Suzanne Warner
Centre for Developmental Psychiatry & Psychology, Monash University
beyondblue Victorian Centre of Excellence
Project completion year
This project compared three treatments for adolescent depression – Cognitive Behaviour Therapy (CBT), antidepressant medication (sertraline) with supportive counselling, and a combination of CBT and sertraline – to determine the most effective treatment.
Participants were aged between 12 and 18 and had been assessed as having depressive disorders. Members of the CBT group received twelve 50-minute sessions. Separate sessions were also scheduled for their parents. The antidepressant treatment schedule included weekly monitoring by medical practitioners and supportive counselling. The combined treatment comprised antidepressant therapy, along with 12 sessions of CBT and parents’ sessions. Assessment of ongoing benefits occurred six months after treatment completion.
Factors such as self-efficacy and family functioning were also measured in order to understand which might predict relapse or a lack of response to treatment.
The project also aimed to train and support GPs and community youth mental health workers to manage depressed young people in their own rural or metropolitan communities.
Analysis of the data demonstrated improvements in all treatment groups. The combined treatment was not superior to CBT or medication alone. CBT was as effective as combined CBT and drug therapy. Response to CBT alone was more rapid, with therapeutic gains still evident at follow-up. CBT was superior to medication for the acute treatment of mild to moderate depression among adolescents.
Low self-efficacy, poor levels of family functioning, high levels of self-reported anxiety, and depressed and irritable mood predicted depression at the six-month follow-up.
The project also provided training and support for general practitioners, psychiatric registrars, primary mental health clinicians, school welfare coordinators and school psychologists. Training sessions were well received by health professionals with more than 250 attendees across Victoria. Training focused on the CBT modules used in the study.
Implications for policy, practice and further research
Data from a further 56 patients will be analysed during a second phase of the study. Combined results will provide information for clinicians treating adolescents with depression and improve understanding of factors that influence response.
The expertise gained through this project has resulted in a successful tender to design an advanced training course in CBT for the Australian Division of General Practice and beyondblue.