“My son is 16 and he is clearly depressed for a while now. He doesn’t want to go to school and he stays in his room all day. I want to seek treatment for him. But do these treatments work in adolescents, or do they only work in adults?”
Yes, these treatments are effective
Yes, treatments of depression in adolescents are certainly effective. Many well-designed studies have shown that psychotherapies are effective in adolescents. And based on this research, psychotherapies are recommended in all guidelines for clinicians on how to treat depression in adolescents. There are, however, several issues that are important to know about psychotherapy for depression in adolescents.
Why the effects can look smaller than in adults
The effects of treatments are usually examined by comparing such treatments with control conditions in randomized controlled trials. A treatment is considered effective when participants in the treatment group are doing better than those in the control group, who did not get the treatment. These studies have shown that psychotherapies for adolescents with depression are indeed effective compared to the control conditions. However, the size of the effects is substantially smaller than the size of the effects found in adults.
One could conclude therefore that the effects are smaller in adolescents compared to those in adults. This difference in effect size is, however, not caused by lower response rates in adolescents who receive therapy, but by higher response rates in the control conditions. Both in adolescents and in adults the response rate (50% symptom reduction from the start to the end of the therapy) is around 40%. The response rate in the control conditions is much higher in adolescent studies (>25%) compared to studies in adults (16-17%).
So, when you go into therapy, the chance of getting better is not different between adults and adolescents.
Only a few therapies have been shown to work
There are only a few types of therapy that have been found to be effective in the treatment of adolescents. In most meta-analyses, in which the results of individual effect sizes are statistically integrated into one estimate of the effects, it is found that cognitive behavior therapy and interpersonal psychotherapy are effective in adolescents:
- Cognitive behavior therapy helps people identify and change unhelpful thought patterns and behaviors that maintain depression, and to replace them with more balanced thinking and healthier, mood-improving actions.
- Interpersonal psychotherapy helps people improve their mood by addressing relationship problems, communication patterns, and major life changes that contribute to or maintain depression.
In a new study that will be published soon, we found that behavioral activation is also effective in the treatment of depression in adolescents. Behavioral activation helps people reduce depression by gradually increasing engagement in meaningful, enjoyable, and goal-directed activities while reducing avoidance and withdrawal.
That is a clear difference with adults, where many more types of therapy have been found to be effective in multiple outcome studies and meta-analyses. This limits the possibilities for adolescents. That is important, because the three therapies are effective compared to control conditions, but that does not mean they work for everyone. As we saw, only about 40% of adolescents respond to therapy. That means that if one therapy does not work, there are only two other options that may work.
What about antidepressants?
Next to psychotherapy, antidepressants can also be a treatment option for depression and anxiety in adolescents. This is, however, not recommended in mild depression. It can be an option in more severe depression, but only in addition to psychotherapy, when that does not work sufficiently. Antidepressants are also not easily recommended, because they may result in a small increase in suicidal thoughts or behaviors early in treatment in some adolescents. Fluoxetine is the medication for which most evidence is available.
In summary
So, yes, treatments of depression in adolescents are effective, but that does not mean they work for everyone. The effects of these treatments are modest, and it may take effort to get better. The good thing about seeking professional help is not only that these therapies can be provided, but also that clinicians stay with you when a treatment does not work sufficiently, and they will try to help until the adolescent is doing better, even when it takes long.
- For how well therapy works overall, see Does psychotherapy work?
- For what to do when a first treatment does not help, see What can I do if therapy does not seem to work?
- For how psychotherapy and medication compare, see Medication or psychotherapy for mental health problems?
Pim Cuijpers is professor emeritus of clinical psychology and scientific director of Metapsy. He has been involved in more than 1,100 scientific studies, mostly on psychological treatments of mental health problems. This is one of a series of evidence summaries in which Prof. Cuijpers tries to answer questions from patients and clinicians, based on what is known in science about treatments. The knowledge is mostly drawn from collective work of the Metapsy collaboration of at least 15 years. Do you have other questions you would like Prof. Cuijpers to discuss? Feel free to contact us.
Literature
- Cuijpers P, Miguel C, Ciharova M, Sprenger AA, Lin J, Weisz JR, Karyotaki E, Stikkelbroek Y, Harrer M. (2026). Psychotherapies for depression in children and adolescents: a systematic review and network meta-analysis. World Psychiatry, in press.
- Cuijpers P, Karyotaki E, Ciharova M, Miguel C, Noma H, Stikkelbroek Y, Weisz JR, Furukawa TA. (2023). The effects of psychological treatments of depression in children and adolescents on response, reliable change, and deterioration: A systematic review and meta-analysis. European Child and Adolescent Psychiatry, 32, 177–192. https://doi.org/10.1007/s00787-021-01884-6
- Cuijpers P, Karyotaki E, Eckshtain D, Ng MY, Corteselli KA, Noma H, Quero S, Weisz JR. (2020). Psychotherapy for depression across different age groups: A meta-analysis. JAMA Psychiatry, 77(7), 694–702. https://doi.org/10.1001/jamapsychiatry.2020.0164
