Short-term efficacy of cognitive behavioral therapy plus sertraline vs sertraline monotherapy for adolescent depression: A randomized controlled study

Abstract

BACKGROUND

Depression in children and adolescents has become a serious public health problem that threatens their physical and mental health, and effective short-term interventions are particularly crucial. Most existing treatments are either pharmacological or psychotherapy, but limited studies have evaluated whether a combination of intervention models leads to superior outcomes.

AIM

To compare the short-term efficacy of cognitive behavioral therapy (CBT) plus sertraline vs pharmacological treatment alone (sertraline) in adolescents with depression.

METHODS

A single-center randomized controlled study was conducted, and a total of 100 adolescent patients with depression were included who met the diagnostic criteria based on the inclusion and exclusion criteria. The patients were randomly divided into two groups: 50 patients in the study group, who received a comprehensive intervention model (CBT treatment + sertraline treatment + ecological intervention), and 50 patients in the control group, who received only systematic sertraline monotherapy. The Children’s Depression Inventory (CDI) was used to evaluate short-term efficacy in both groups. The Adverse Reaction Symptom Scale (TESS) was used to evaluate treatment safety.

RESULTS

The results showed that there was no significant difference in CDI scores between the two groups before treatment (15.9 ± 6.5 vs 13.6 ± 7.3, P > 0.05). After 3 months of treatment, the median CDI score in the study group was 5 points (interquartile range, 3 points) and in the control group it was 7.5 points (interquartile range, 8 points), with a significant difference between the two groups (Z = -3.052, P < 0.05). After 3 months of treatment, the median TESS score in the study group was 6 points (interquartile range, 3 points) and the median TESS score in the control group was 5 points (interquartile range, 5 points). There was no statistically significant difference between the two groups (P > 0.05); the incidence of various types of side effects (such as extrapyramidal reactions and cholinergic symptoms) was similar between the two groups (all P > 0.05). The main adverse events were mild muscle stiffness (6%) and dry mouth (6%-8%). No serious adverse reactions occurred.

CONCLUSION

The comprehensive treatment model of CBT combined with sertraline and ecological intervention was significantly better than drug therapy alone in improving depression in children and adolescents in the short term, and demonstrated a good safety profile. This model should be promoted in clinical practice to improve the overall effectiveness of treatments for adolescent depression.

Keywords: Adolescent depression; Intervention; Children’s Depression Inventory; The Adverse Reaction Symptom Scale; Randomized controlled trial

Core Tip: This study showed that cognitive behavioral therapy based on ecological intervention combined with sertraline had better short-term efficacy than sertraline alone in the treatment of adolescent depression, and the safety profile was comparable. These results provide an empirical basis for the clinical selection of high-efficiency and low-risk adolescent depression treatment regimens. In the future, it is necessary to further verify the long-term effectiveness of the intervention, and explore comprehensive intervention strategies for comorbid factors such as sleep management and metabolic health.