384 American Family Physician www.aafp.org/afp Volume 94, Number 5 ◆ September 1, 2016
CBT Effective in Adolescents
with Depression Who Do Not
Is cognitive behavior therapy (CBT) effective
for adolescents with depression who decline
antidepressant drug treatment?
In adolescents who eschew drug treatment of
major depression, short-term CBT is more
effective than treatment as usual in inducing recovery, with a number needed to treat
of 4 to 10. CBT also produced faster results.
(Level of Evidence = 1b)
These researchers identified potential patients
by mailing study brochures to parents of
adolescents 12 to 18 years of age who had
a recent prescription for an antidepressant
(from a health maintenance organization in
the United States) that went unfilled or was
initially dispensed but not refilled. In other
words, the patients did not fail antidepres-
sant therapy but simply chose not to begin
(or continue) it. The 212 adolescents who
had major depressive disorder were random-
ized (allocation concealment uncertain) to
continue treatment as usual (as determined
by their primary care clinician) or treatment
as usual plus at least four sessions of CBT
aimed at addressing unrealistic thinking and
increasing pleasant activities (behavioral acti-
vation). The patients could continue a second
set of four to six sessions, if desired, and most
did. Recovery, defined as at least eight weeks
of well time as measured by the Children’s
Depression Rating Scale—Revised, occurred
significantly faster in the CBT group and
was significantly more likely in the first year
but not the second year of follow-up. Qual-
ity of life was better with therapy in the first
year after therapy but not in the second year.
Hospital admissions for psychiatric diagno-
ses were significantly higher in the control
group. Substance use, suicidal behavior, and
parent-reported outcomes were not different
between the two groups, but the study may
not have been long enough to find a differ-
ence, if one exists. These results agree with the
results of several meta-analyses examining the
effect of CBT for adolescents with depression.
Study design: Randomized controlled trial
Funding source: Government
Setting: Outpatient (primary care)
Reference: Clarke G, DeBar LL, Pearson JA, et al.
Cognitive behavioral therapy in primary care for
youth declining antidepressants: a randomized trial.
ALLEN F. SHAUGHNESSY, PharmD, MMedEd
Professor of Family Medicine
for Hypoactive Sexual Desire
Disorder in Women
Is flibanserin (Addyi) a safe and effective
treatment of hypoactive sexual desire disorder in premenopausal women?
Flibanserin produces a minimal effect on
sexual desire and minimally increases the
number of satisfying sexual events in women
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Copyright Wiley-Blackwell. Used with permission.
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