Effectiveness And Cost Effectiveness Of Cognitive Behaviour Therapy And Short-Term Psychoanalytic Psychotherapy Compared With Brief Psychosocial Intervention In The Maintenance Of Symptomatic Remission In Adolescents with Unipolar Major Depression (IMPACT): A Randomised Controlled Trial
One in ten teenagers referred to child psychiatrists has significant depression, and a third of adult mood disorders begin in adolescence. This matters because adolescent depression often recurs into adulthood, raising risks of suicide and long-term impairment. Until now, no trial had compared different psychological therapies head-to-head to see which best prevents relapse in young people. The IMPACT trial randomly assigned teenagers with moderate to severe depression to one of three treatments: a brief psychosocial intervention, cognitive behaviour therapy, or short-term psychoanalytic therapy. Patients could also receive antidepressant medication if needed. If the trial identifies which therapy is most effective and cost-effective at maintaining remission, it could directly change how the NHS treats adolescent depression. Instead of relying on one standard approach, clinicians could choose the therapy most likely to keep young people well into adulthood, reducing recurrence and the personal and social costs of chronic depression. The findings could reshape treatment guidelines for child and adolescent mental health services, improving long-term outcomes for a condition that affects personal competence and wellbeing for more than a third of young sufferers.
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Major depression in adolescents is an important problem for the NHS. Around 1 in 10 referrals to child psychiatrists have significant depressive conditions. Clinical cases have many social and cognitive impairments and significantly increased risks of both attempted and completed suicide and a high rate of recurrence in adulthood. Indeed, it seems that around 30% of adult affective disorders start in adolescence. A reduction in the duration and number of episodes in adolescence could therefore not only reduce short-term morbidity but also help to prevent depressive conditions and suicidal behaviour later in life. IMPACT (Improving Mood with Psychoanalytic and Cognitive Therapies) is a new clinical trial whose objective is to determine the most clinical and cost effective treatment that will reduce the risk of recurrence of clinical depression in young people. Our objectives are to compare three different types of psychological therapies in moderately to severely depressed adolescents attending CAMHS. We will randomise 540 (180 to each treatment arm) adolescents with unipolar major depression to one of three treatments : i) active clinical care lasting 12 weeks ii) cognitive behaviour therapy lasting 20 weeks iii) short term psychoanalytic therapy lasting 30 weeks. Cases in any arm may receive an antidepressant medication (fluoxetine is the medication of choice) if required according to the NICE guidelines. The patients will be reassessed up to and including 12 months after the end of treatment to determine the proportion of case who relapsed or showed persisting depressive symptoms and disorder. This is first trial in adolescents to investigate the best treatment to prevent relapse of this serious mental illness in young people that has devastating consequences on personal competence and well being through into adult life for more than a third of young sufferers.
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