Brief, Primary Care CBT for Unmedicated Depressed Youth

Kaiser Foundation Research Institute, Oakland CA

Investigators

Linked publications & trials

Abstract

[unreadable] Substantial numbers of depressed adolescents either decline antidepressant medication or quickly[unreadable] discontinue such medications before benefits are expected. Recent controversies regarding the safety[unreadable] of SSRI anti-depressants are likely to increase medication refusal. More than half of depressed[unreadable] adolescents identified in primary care prefer psychosocial treatments, compared to.20% who prefer[unreadable] medication. Among the psychotherapy alternatives to medication, CBT has the strongest research support.[unreadable] We have already developed a collaborative care CBT model that we evaluated in a previous primary care[unreadable] trial. However, this previous trial did not specifically examined its effects in the absence of medication[unreadable] treatment. Therefore, we propose to conduct a two-arm, randomized, efficacy-effectiveness trial in a[unreadable] Health Maintenance Organization (HMO), comparing a treatment as usual (TAD) control condition to TAU[unreadable] plus brief, individual, collaborative care CBT. We will enroll 240 youth ages 12 to 18 who, during this[unreadable] depressive episode, have either declined anti-depressant medication or who received a single dispense of[unreadable] anti-depressant medication but quickly discontinued. All enrolled cases will be reassessed periodically[unreadable] throughout a 24-month follow-up period. The primary clinical outcome is recovery from the index episode of[unreadable] major depression, assessed via LIFE/K-SADS diagnosis. Secondary outcomes include continuous[unreadable] depression symptomatology; depression response; rates of new, recurrent episodes of major depression in[unreadable] the follow-up period; improvements in psychosocial function; clinical improvement; reduction in depressionrelated[unreadable] dysfunction; parent/youth attitudes regarding treatment. We will also examine incremental costeffectiveness[unreadable] of CBT compared to TAU from the HMO, family, and societal perspectives. We will conduct[unreadable] exploratory analyses of mediation and moderation of depression treatment outcomes, and employ data from[unreadable] the TAU control condition to estimate the usual outcomes for depressed youth who refuse/discontinue[unreadable] antidepressant medication. Finally, we will examine how provider, parent and youth barriers, attitudes[unreadable] and beliefs moderate outcomes, as well as possibly change over time as a function of participation[unreadable] in this program.[unreadable] The validation of a primary care model for brief CC-CBT may prove to be a significant benefit to[unreadable] the sizeable numbers of depressed youth identified in primary care, and who elect not to try antidepressant[unreadable] medication or quickly discontinue an initial trial.