A22 22..22

Four randomised controlled trials (RCTs) and one RCT metaanalysis are featured in the Journal this month. The latter is a review of trials of newer-generation antidepressants and cognitive–behavioural therapy (CBT) for adolescent depression (Dubicka et al, pp. 433–440). In an area of clinical practice plagued by controversy, the authors of this review were able to contribute the finding that adding CBT to antidepressants confers only limited advantage over the use of antidepressants alone. They found no benefit in terms of impact on depressive symptoms, suicidality or global improvement after acute treatment or at follow-up but did find a significant advantage of the combination for short-term impairment. In a randomised experimental study, Mendel et al (pp. 441–447) tested whether psychiatrists are prompted to reveal their personal rather than professional perspectives on treatment recommendations when confronted with a patient asking ‘What would you do if you were me, doctor?’ The authors did not find evidence for such a change in recommendation role prompted by this question but did find that psychiatrists tended to choose different treatments for themselves than those they recommended to patients. In a Dutch study of treatment adherence therapy – an intervention tailored to the reasons for an individual’s non-adherence to psychosis treatment – improvements in service engagement and medication adherence were found (Staring et al, pp. 448–455). A trend towards reduction in involuntary readmissions was also noted. In a 6-year follow-up of patients with borderline personality disorder randomised to 1 year of CBT or treatment as usual, Davidson et al (pp. 456–462) found that the initial benefits seen in suicidal behaviour were maintained and, although a statistically significant cost-effectiveness advantage was not found, the cost of services was lower in the CBT group. In line with other longitudinal studies, the authors also found that less than half those meeting criteria for borderline personality disorder at study entry continued to do so at the 6-year follow-up point. Finally, Klug et al (pp. 463–467) report on the results of an RCT of home treatment v. conventional out-patient care for depression in the elderly. Those receiving home treatment had fewer depressive symptoms, better global functioning and a higher subjective quality of life at both the initial (3 month) and later (12 month) follow-up point. Advantages in care costs and likelihood of nursing home or in-patient admission were also found.