Uncertainty over what works best to prevent relapse of childhood depression


Much of the research about depression in children and adolescents focuses on how to treat the illness during the acute phase. This review from the Cochrane Depression, Anxiety and Neurosis Review Group is more concerned with the ways in which interventions can be used to prevent relapse or recurrence of depressive disorders.

The review looks specifically at two types of depression: major depressive disorder and dysthymic disorder. Only trials involving young people with validated diagnoses of these conditions were included in the analyses.

The reviewers searched a wide range of databases and found 9 randomised controlled trials (including a total of 882 patients). Unfortunately the quality of the included trials was not high. The problems included:

  • Unclear blinding of outcome assessors (in 4 of the 9 trials)
  • Patients not blinded to the treatment they were receiving (in most trials)
  • Unclear allocation concealment (in most trials)
  • Diverse trial design, which limits the applicability of the findings

Here’s what they found:

  • 3 of the RCTs showed that during the relapse prevention phase, patients treated with antidepressants relapsed less (40.9%) than those on placebo (66.6%) – odds ratio (OR) 0.34; 95% confidence interval (CI) 0.18 to 0.64, P = 0.02
  • 1 RCT concluded that combination therapy (antidepressants and talking treatment) did better than antidepressants alone, but this result did not reach statistical significance (OR 0.26; 95% CI 0.06 to 1.15)
  • Most of the antidepressant trials provided side effects data, but this was insufficient to draw any conclusions about which drug had the best side effect profile

The reviewers concluded:

Currently, there is little evidence to conclude which type of treatment approach is most effective in preventing relapse or recurrence of depressive episodes in children and adolescents.

Limited trials found that antidepressant medication reduces the chance of relapse-recurrence in the future, however, there is considerable diversity in the design of trials, making it difficult to compare outcomes across studies.

Some of the research involving psychological therapies is encouraging, however at present more trials with larger sample sizes need to be conducted in order to explore this treatment approach further.


Cox GR, Fisher CA, De Silva S, Phelan M, Akinwale OP, Simmons MB, Hetrick SE. Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.:
CD007504. DOI: 10.1002/14651858.CD007504.pub2.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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