Options for treating depression in adolescents

Many adolescents in Aotearoa New Zealand present with depressive-like symptoms, including but not limited to feelings of sadness, loneliness, hopelessness and difficulty sleeping, eating and concentrating.  It’s important that these are treated because maintenance of the symptoms below a certain level is associated with less risk of depression in adulthood.  My experience is often medical practitioners and the general population know about and recommend CBT (cognitive behavioural therapy), but don’t know much about alternatives.

The Lancet Psychiatry published a research article in 2017 demonstrating the effectiveness of psychoanalytic psychotherapy (which is what I practice) for treating depression in adolescents in England.  It found that psychoanalytic psychotherapy is equally good as CBT (cognitive behaviour therapy) and psycho-social intervention.

The Lancet article outlines three treatment methods that researchers trialled.  It found that they all had equal effectiveness.  This means that adolescence and their whānau have a choice of treatments in terms of effectiveness (if they have to access to them all), or, if they only have access to one of them, they can be assured that this research found each intervention was as good as the other two interventions, for a general English population.

The three treatments the researchers compared were:

Psychoanalytic psychotherapy- this intervention is based on the relationship the young person makes with their therapist.  The young person is encouraged to see the therapeutic task as understanding feelings and difficulties in their life.  The therapist is non-judgemental and enquiring and conveys the value of self-understanding.   In the trial, the young person saw the therapist (child and adolescent psychotherapists) for about 30 sessions.  This is the intervention that I practice.  

CBT (cognitive behavioural therapy)- this intervention is based on the classic form used for adults with depression.  The focus is to identify thoughts that maintain depression and low mood and to amend these.  In my experience, “coping skills”, “strategies” are explicitly taught.  The young person saw the therapist (clinical psychologists with CBT training) for about 20 sessions.

Psychosocial intervention- this intervention was based on psycho-education, action-oriented and goal-focussed.  Self-understanding or cognition change were not components of the intervention.  The young person saw the therapist (clinicians at public mental health services) for about 20 sessions. 

It is important to note that these interventions were found equally effective across a population of young people in England.  If you have a choice for your young person, consider which of these interventions might work best for their temperament, background, culture, situation, and developmental stage.  For example, my sessions are usually unstructured and can incorporate playing, art, movement and working with whatever the young person brings on the day.  Equally we can sit and talk.  This flexibility and creativity will suit some children.  Also, an important part of choosing an intervention is the fit with the therapist when you and your person meet them.  Try and find someone who “feels right”.  Of course, there may be other treatments than these three that you consider, for example those based in faith or cultural contexts.  If those are not working though, please consider seeking help with a registered health professional, starting with your GP.

The article referenced can be found at


Goodyer, I. M., Reynolds, S., Barrett, B., Byford, S., Dubicka, B., Hill, J., Holland, F., Kelvin, R., Midgley, N., Roberts, C., Senior, R., Target, M., Widmer, B., Wilkinson, P., & Fonagy, P. (2017). Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial. The Lancet Psychiatry, 4(2), 109-119. https://doi.org/10.1016/s2215-0366(16)30378-9

Photo by Yuris Alhumaydy on Unsplash


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