June 2, 2009 — Teaching at-risk teens skills to help them identify negative thinking and better deal with their problems can reduce the incidence of depression, new research confirms.

The study compared outcomes among teens who were and were not enrolled in a cognitive behavioral therapy program.

With the exception of those living with a parent who was depressed, teens who took part in the program were significantly less likely to develop clinical depression over the course of the eight-month study.

The study, which appears in the June 3 issue of the Journal of the American Medical Association, is one of the largest ever to show that teaching positive thinking and coping strategies can prevent depression in at-risk adolescents.

“We know that these kids tend to interpret situations in overly negative ways,” study co-author Gregory N. Clarke, PhD, of Portland, Oregon’s Kaiser Permanente Center for Health Research tells WebMD. “The idea is to teach them the skills they need to keep unrealistic thinking from snowballing into full-blown depression.”

Most Depressed Teens Aren’t Treated

Depression among teens often goes unrecognized and untreated. Studies suggest that only about one in four depressed adolescents receive any kind of treatment.

Cognitive behavioral therapy (CBT) has been shown to be an effective treatment for depression in teens, either alone or in combination with antidepressant drugs.

In a 2007 study, the combination of CBT and a selective serotonin reuptake inhibitor (SSRI), which is a class of antidepressant medication, was found to be more effective for treating major depression than either treatment alone.

In another study, reported in February, the combination of CBT and an antidepressant was more effective than drug therapy alone in the treatment of teens who had not responded to initial drug treatment.

In the newly published study, researchers evaluated the effectiveness of a cognitive behavioral intervention program for preventing depression in 316 at-risk teens.

All of the study participants had at least one parent who was depressed or had a history of depression and some had been treated for depression themselves.

Half were randomly assigned to the intervention program, which consisted of eight weekly 90-minute group sessions followed by six monthly 90-minute sessions.

The sessions were led by a therapist who taught problem-solving skills and other strategies designed to help the teens recognize and change unrealistic and overly negative thinking.

Compared to participants who did not get this intervention:

• Those who did were less likely to develop depression during the course of the study, with about one in five (21%) experiencing new depressive episodes compared to one in three (33%).
• The impact of the intervention was most dramatic in adolescents who did not have a parent who was depressed at the time, with 12% of these teens developing depression vs. 40% of teens who did not go through the program.
• The researchers estimated that the intervention prevented one episode of depression for every nine teens treated — a risk reduction similar to that which has been reported for antidepressants.

Having a parent who was actively depressed at the start of the study significantly reduced the effectiveness of the intervention, lead researcher Judy Garber, PhD, tells WebMD.

“It may be that there is more conflict at home or that the parent is just too depressed to help them or it may be a marker of greater genetic vulnerability,” she says.

CBT Not Widely Available

Duke University psychology professor John Curry, PhD, was a co-author of the 2007 study showing cognitive behavioral therapy combined with an antidepressant to be more effectiveness than either treatment given alone.

Curry tells WebMD that behavioral intervention programs are not widely available to depressed teens and teens at risk for depression.

“Cognitive behavioral therapy is still not taught in a lot of graduate programs and it is not easy to find therapists who do it,” he says.

Most depressed teens who are treated receive either antidepressants alone or antidepressants with conventional psychotherapy, and most at-risk teens receive no treatment at all, Curry says.

“In teens, a big part of the problem is that symptoms aren’t recognized for what they are. They are dismissed as the normal problems associated with growing up,” he says. “If we can identify kids who are at risk, that is a big part of the battle.”