Editorial: For Adolescents With Subthreshold Depression, Is an Ounce of Prevention Worth a Pound of Cure?

Globally, depression is among the leading neuropsychiatric disorders of adolescence. Conventional wisdom indicates that an "ounce of prevention is worth a pound of cure," a perspective bolstered by some studies demonstrating that psychological interventions for subthreshold depression reduce acute symptoms and prevent the onset of major depressive disorder (MDD) over short-term follow-up. However, the meta-analysis by Cuijpers et al., the first to pool results from all available relevant studies in the field, provides evidence that would seem to challenge this conventional wisdom. The meta-analysis included 12 randomized controlled trials of children and adolescents. This editorial focuses on the 10 studies with adolescents (age range, 13.5-17.4 years), who were recruited from schools (n = 6), medical settings (n = 3), and mass mailings (n = 1). The youths received short-term psychotherapies ranging from 6 to 16 sessions, primarily cognitive-behavioral therapy or interpersonal therapy, or inactive control/care as usual. Results showed significant short-term benefits in reducing acute depression symptoms, even though effect size was small to medium (number needed to treat = 8.4). At 6-18 months of follow-up, however, the likelihood of meeting full criteria for MDD was not significantly different between the intervention and control conditions. We child and adolescent psychiatrists have difficulty yielding our commitment to conventional wisdom and look for evidence that this meta-analysis is not the last word on the value of early interventions for subthreshold depression to prevent MDD in adolescents.