Wolfson Centre lectures: Fundamental problems in the evidence base of adolescent depression treatment

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There are two principal treatment modalities for adolescent depression:  psychotherapy, medication, or their combination. Where does one turn to find the evidence that will inform their treatment options? This question is relevant for patients and their carers, for clinicians and for policy makers when they plan services. However, the question is particularly difficult to answer for adolescent depression, where there are limited data from head-to-head trials of medication and psychotherapy, and where recommendations must therefore be derived from indirect comparisons of treatment efficacy.

In this talk, Professor Argyris Stringaris will examine whether the existing evidence base for adolescent depression treatment can offer valid answers to such questions. He will provide a conceptual framework for answering such questions and argue along three points:

1. Psychotherapy and Medication trial participants are probably drawn from different populations which threatens inferences drawn about their comparison.
2. The controls employed in psychotherapy and medication adolescent depression trials differ qualitatively but also in their effects as to suggest that they cannot both represent the same “control condition”, i.e. a reasonable counterfactual of how it would be if someone did not receive treatment.
3. Psychotherapy control conditions in youth depression trials are, on average, poorly matched to the intervention condition (e.g. number of hours exposed to a human, number of sessions, plausibility of the control condition), leading to concerns about whether they are fair comparators, according to standards one would generally expect from other interventions in the health sciences.

Professor Argyris Stringaris discusses these issues in view of guidelines, clinical decision making and will make some suggestions about future trials.