Can You Prevent Depression Before It Arrives?

Some teen depression potentially prevented with use of cognitive behavior therapy

(RxWiki News) Mental health disorders can be challenging to treat in some patients. In a perfect world, a condition like depression could be prevented before it occurs. That may sometimes be possible for at-risk teens.

A recent study found that teens at a higher risk for depression were less likely to have a depressive episode after participating in a therapy program.

The program used a treatment called cognitive behavioral therapy.

This type of therapy is available through most mental health clinics and mental healthcare professionals.

"Tell your doctor if you're feeling depressed."

The study, led by William R. Beardslee, MD, of the Department of Psychiatry at Boston Children's Hospital, looked at the effectiveness of a group cognitive behavioral therapy program for teens at higher risk for depression.

The researchers tracked 316 teens, aged 13 to 17, at four different sites for nearly three years (33 months).

The sites included a health maintenance organization (HMO), two university medical centers and a community mental health center.

The teens were all considered at high risk for developing depression because their parents had been diagnosed with a depressive disorder.

At the start of the study, the teens did not currently meet the criteria for a depression disorder, but they either had a history of depression or increased depression symptoms at that time.

The teens were split into two groups. One group participated in an 8-week cognitive behavioral therapy program involving 90-minute group sessions once a week.

Cognitive behavior therapy is a type of talk therapy that teaches individuals how to reframe the way they perceive their circumstances and how to train themselves to respond in healthy way to their emotions and experiences.

These teens then participated in six continuing sessions, once a month, over the following six months.

The other group of teens was assigned to receive "usual care," which means they did not receive any additional or special care beyond what a typical teen would receive from their primary care providers.

The researchers compared how many teens in each group developed an episode of depression that lasted at least two weeks during the nearly three years of follow-up.

Overall, the researchers found that fewer of the teens who participated in the cognitive behavioral program experienced episodes of depression than teens receiving usual care.

About 36.8 percent of the teens undergoing the cognitive behavior program experienced a depressive episode, compared to 47.7 percent of the teens receiving usual care.

For every 10 teens participating in the cognitive behavioral program, one was prevented from developing a depressive episode due to the treatment.

However, whether the teens experienced a depressive episode during follow-up also depended in part on whether their parents were depressed at the time the teen began the program.

Among children of parents who were not depressed at the start of the program, one teen would be prevented from developing a depressive episode for every six teens undergoing the cognitive behavior program.

However, among teens of parents who were depressed at the start of the study, neither the cognitive behavior program nor usual care appeared to make a difference in whether a teen experienced a depressive episode.

The extent to which the parents' level of depression affected the teens' risk of a depressive episode appeared to vary based on the type of clinic the teens attended.

"The current study demonstrated the durability of the effects of the CBP program for preventing depressive disorders in at least some high-risk adolescents," the researchers wrote.

The success of the therapy treatment for teens, however, does appear related to the mental health of the parents at the time a teen begins receiving care.

While the particular cognitive therapy behavior program described in this study may not be available in all areas, the use of cognitive behavioral therapy is a very common treatment available through most mental health clinics and care providers.

Seanna Crosbie, LCSW, director of program services at Austin Child Guidance Center, said that cognitive behavioral therapy (CBT) is one of the most researched supported treatments for depression.

"It is easy for adolescents to use and can be modified for younger children too," Crosbie said. "CBT works by helping the client examine the connection between thoughts, feelings and behaviors."

Crosbie provided an example of how the treatment works.

"When we have negative thoughts, those thoughts typically lead to bad feelings," Crosbie said. "So, CBT helps clients to develop more adaptive and balanced ways of viewing a situation.  Instead of thinking 'I don’t know algebra and that means I am stupid,' a client may replace that thought with 'I don’t know algebra, but I am learning and will get help with math.'" 

Crosbie said that many practitioners are families with using CBT.

"If you are looking for a CBT therapist, do your research about their background – interview the therapist and ask them their experience using CBT approaches," she said.

The study was published September 4 in the journal JAMA Psychiatry. The research was funded by the National Institute of Mental Health and the National Center for Research Resources (National Center for Advancing Translational Sciences).

One author is a member of the editorial board for UpToDate and receives royalties from Guilford Press. No other conflicts of interest were reported.

Review Date: 
September 5, 2013