CBT Cost-Effective for Adolescents Declining Antidepressants

depressed girl
depressed girl
Cognitive behavior therapy may be a cost-effective long-term treatment for adolescents with depression.

Brief cognitive behavioral therapy (CBT) in a primary care setting effectively reduces depression symptoms in adolescents aged 12 to 18 who decline antidepressant therapy and significantly reduces costs by the second year, according to a study published in Pediatrics.

Participants were recruited from a large US not-for-profit health system between 2006 and 2010. To qualify, participants had to be aged 12 to 18 with a diagnosis of major depression according to the Children’s Schedule for Affective Disorders and Schizophrenia. Participants were excluded for bipolar disorder or psychosis, current antidepressant use, autism spectrum disorder, mental retardation, imminent risk for suicide, pervasive developmental disorder, or having received more than 8 CBT sessions prior to the study. The 212 adolescents in the sample were randomly assigned to a treatment as usual plus CBT group or a treatment as usual control group.

Assessments were performed by independent evaluators at baseline, then again at 6, 12, 26, 52, 78, and 104 weeks, using the Children’s Depression Rating Scale-Revised. For the 12 and 24-month analyses, symptoms were summarized into depression-free days, partial-depression days, and full-depression days. To correspond with study enrollment (2006 to 2010), enumerated costs were adjusted to 2008 dollars using the medical care services standards from the Bureau of Labor Statistics Consumer Price Index. Economic costs analyzed included cost of intervention services (determined via accounting records and estimations from CBT therapists), usual care costs (such as outpatient encounters, inpatient stays, medications, and social services), and family costs (ie, the value of parents’ time spent off work, traveling, and waiting).

The study’s CBT program utilized ≤ 9 acute sessions from master’s level therapists to address behavior modification and/or unrealistic thinking. Participants could choose to end or pause therapy partway through, which resulted in an average of 6.4 CBT sessions per participant (median=7).

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Findings demonstrated that CBT had a significant advantage over treatment as usual for the reduction of depression symptoms, resulting in an average of 26.8 more depression-free days over the course of 12 months. Costs were not statistically different between the 2 groups at 12 months, but CBT was ultimately demonstrated to be cost-saving by the second year, with a $4976 reduction in total cost by the 24-month follow-up.

Study investigators conclude, “brief, primary care-based CBT is a cost-effective option for the treatment of depression among adolescents with depression who decline or quickly discontinue pharmacotherapy… [and] may be a beneficial treatment option for health systems to implement.”


Dickerson JF, Lynch FL, Leo MC, DeBar LL, Pearson J, Clarke GN. Cost-effectiveness of cognitive behavioral therapy for depressed youth declining antidepressants. Pediatrics. 2018;141(2):e20171969.