1. THE EFFICACY OF COMBINED CBT AND MEDICATION
TREATMENT IN ADOLESCENT DEPRESSION
Ayodeji Owolabi
Sept.
2015

2. Presentation Outline
 Introduction
 Purpose of study
 Facts about depression
 Local & Global statistics
 Cognitive Behavioral Therapy (CBT)
 Other Cognitive Therapy
 Conclusion
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3. Study Objectives
 To demonstrate the efficacy of the combined CBT-medication treatment
for adolescent depression.
 To outline the theories of psychotherapy and stress the importance and
need to incorporate these theories into training of new and experienced
therapists.
 To better the reader’s comprehension of Cognitive-behavioural therapy.
 To discuss the role of religion in diagnosis of depression.
 To emphasize the need for adequate and effective treatment of
depression.
 To discuss trends in pharmacotherapy for adolescent depression.
 To highlight the reluctance to diagnose border personality disorders
among adolescents.
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4. Study Rationale
 Adolescent depression is a severe disorder that needs to be tackled
vigorously. Adolescence is sensitive considering it is a formative stage
into adulthood.
 Adolescents with depression are pre-disposed to violent behaviour,
anger and self-harm.
 There is need to handle this concern as results could be disastrous to
both adolescents and individuals surrounding them
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5. Significance of Study
Depression is fast becoming a global public health concern with a high risk
factor for suicide and substance abuse in adolescents. This study will:
 Create increased awareness on the incidence, prevalence and
manifestations of depression in adolescents in United Kingdom.
 Document information on the negative impact of depressive disorders
to both the sufferer and the society at large
 Add to existing wealth of knowledge the effectiveness of CBT
treatment in adolescent depression
 Emphasize the need for increased reliance on Cognitive Behavioural
Therapy than antidepressants
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6. Introducing the disorder
• Depression is a severe, frequently occurring, recurrent disorder
associated with decreased role functioning and quality of living, medical
morbidity and mortality (Spijker et al 2004).
• Touted 4th major cause of disability globally by the WHO (Murray & Lopez
1996).
• Predicted 2nd chief cause of disability by the year 2020.
• Reluctance to diagnose depression in adolescents
Signs & symptoms
of depression
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7. Introducing the disorder- effect of depression
Comorbidities associated
with depression
• Stroke
• Heart attacks
• Substance dependence
• Cancer
• Asthma
• Diabetes
• Hypertension
• HIV/AIDS
• PTSD, etc.
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8. Introducing the Intervention
• Cognitive-behavioural therapy (CBT) is a short-term psychological intervention
that employs a practical approach to problem-solving with an aim to altering
one’s pattern of thoughts or behaviours that underlie their problems (Martin
2007). Studies have deemed CBT to be an efficacious and highly recommended
treatment for depressed adolescents (Kendall 2011, March et al 2004, Wright et
al 2014).
• It has wide applications in old and contemporary medicine.
• Studies have demonstrated efficacy in the combined treatment of CBT and
antidepressant medication (TADS, 2007; Emslie et al 2010).
• Antidepressants to dissipate physical symptoms and CBT for cognitive
restructuring and skill development for handling negative events.
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9. Introducing the Intervention
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10. Introducing the Intervention
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11. Methodology(1)
Groundwork will be structured based on the PRISMA 2009 (Eden et al 2011) and
CONSORT 25-item checklists (Schulz et al 2010).
LITERATURE
• MEDICAL, PSYCHOLOGICAL & PSYCHIATRIC DATABASES : MEDLINE, PSYCHINFO.
• JOURNALS : The International Journal of Mental Health Systems, Journal of Clinical
Child and Adolescent Psychology, American Psychiatric Association, The American
Journal of Psychiatry, Cochrane Depression, anxiety, and Neurosis Review Group’s
Specialised Register/ Studies up to 2010.
• OTHERS : EMbase, Pubmed, Biomedcentral, Sciencedirect, Discover, Scopus,
Medscape, Trials.Org.
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12. Methodology(2)
INCLUSION/EXCLUSION CRITERIA
Careful selection of comparison conditions, their relevance in efficacy trials, pilot
studies, and translational research (Woolf 2008).
DATA EXTRACTION
This was done according to a careful study of guidelines to determine the quality of
measurement properties
SELECTED STUDIES
Papers will be evaluated with aid of the Tulder Criteria (Van Tulder et al 2003)
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13. Majorresults
 The results were classified using DSM-IV-TR criteria.
 Classification of treatments were based on the study by Chambless &
Hollon, (2008).
 Adolescent depression symptoms : moderate to high
 General depressive symptoms: anxiety, substance abuse, Online gaming
addiction.
 Quicker rates of remission, Increased response to treatment, absence
of relapse, decreased suicidal ideation, decreased addiction to online
gaming, reduced levels of anxiety.
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14. Discussions
Clinical Implications (1)
 The TADS research findings can also be applied broadly to the adolescent
population.
 Outcomes from the TADS study suggest physicians can employ the CBT-drug
treatment as an effective long-term therapy for depressed adolescents.
 A good knowledge of predictors and moderators of treatment response may
help identify the most appropriate treatment for each individual.
 These outcomes highlight a need to revisit the current clinical guidelines. The
guidelines suggest following a given treatment approach for eight to twelve
weeks. The study's data instead lends backing to a more active approach in
the 'early days' of treatment for patients who failed to respond. Clinicians
could ponder a more active approach in the ‘early days’ of treatment for
resistant depression e.g., augmentation of medication with psychotherapy or
mood stabilizers, acknowledging that trials have only been done among
adults for these treatments.
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15. Discussions
Clinical Implications (2)
 When mentioned, widening treatment targets to involve comorbid anxiety,
substance dependence, and family issues may be vital to attaining remission
and avoiding relapse.
 Considering psychiatric comorbidities is significant for enhanced treatment
outcomes in adolescents with depression (Kim et al 2012).
 Impact of depression on associated psychopathology.
Limitations
Small effect sizes, referrals outnumbering volunteers for trials, failure to
complete treatment are some of the limitations observed in the trials.
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16.  In spite of apparent limitations in the studies investigating it, using CBT
as an adjunct has overwhelming evidence of its benefits in treating
adolescents with depression. This is also a very cost-effective approach
and has proved effective in addressing suicidal ideation and online
gaming which is a growing trend among our young people today.
 While medication takes care of the physical depressive symptoms,
psychotherapy focuses on changing the individual’s thoughts and
behaviours towards distressing events.
 Clinicians will find outcomes from this study important in future
therapies. The room for further research will also go a long way in
devising new and more effective approaches to tackle adolescent
depression.
Conclusion
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17. Thank you for
listening!!!
Any Questions???