Cost-Effectiveness and Clinical-Effectiveness of Combined Therapy versus Medication Only in Adolescents with Resistant Major Depression

Depression in adolescents is a significant issue. Research has focused on treating major depression in adolescents with psychotherapy (CBT), medication (selective serotonin reuptake inhibitors, SSRIs), or a combination of both.  As treatment is not inexpensive, researchers have been looking into the cost-effectiveness of different treatment models.  Previous research has shown that CBT treatment and medication is the most expensive treatment model in the short run.  The least expensive model is medication only.  However, some adolescents do not respond to medication alone.

A recent randomized trial was published in the Archives of General Psychiatry. 334 adolescents with SSRI-resistant depression, were randomly assigned to one of two groups for 24 weeks: a change in medication or a change in medication plus CBT.   Throughout the treatment they were assessed at 6, 12, and 24 weeks for symptom changes, depression-free days, and depression-improvement days.  The researchers also examined the clinical outcomes within certain subgroups of participants: patients with histories of abuse, comorbid disorders, and levels of hopelessness.

The study found that using a combined treatment of CBT and medication led to more depression-free and depression-improved days.  It worked best for patients without a history of abuse or with low levels of helplessness.  While the combined treatment was more costly in the short-run, it may be most cost-efficient in the long run.  This study demonstrates the benefits of further examining the use of combined treatment in adolescents with SSRI-Resistant Depression.

Lynch, F. L., Dickerson, J. F., Clarke, G., Vitiello, B., Porta, G., Wagner, K. D., … Brent, D.  (2011). Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor – resistant depression.  Arch Gen Psychiatry, 68 (3), 253-262.