In the per-protocol analysis, remission rates were significantly higher with SPARX than with usual care (43.7% versus 26.4%, P=0.03), and response rates didn’t differ significantly between groups. The authors noted that response and remission rates with SPARX “compare favorably with other effective monotherapies, including antidepressants and cognitive behavioral therapy.”
Merry and colleagues found that effectiveness of SPARX wasn’t related to sex, age, ethnicity, or setting, but participants who were more depressed at baseline had a significantly greater reduction in depression scores with SPARX than those who were less depressed (P=0.038).
They added that there were no differences in adverse events that were potentially related to the intervention.
For children, depression treatment may include psychotherapy either alone or in combination with antidepressant medication. Although opinions vary about which depression treatment should be tried first, a growing body of evidence indicates that the best approach for most children is a combination of both. Treatment is most often provided in an outpatient setting. Sometimes hospital care may be needed. The treatment plan must be tailored to the severity of the child’s symptoms and how they affect his or her development.
Many types of psychotherapy are available. For depression treatment, cognitive behavioral therapy may be especially effective. Children who are depressed often have an unhealthy, negative view of themselves and their experiences. With cognitive behavioral therapy, children learn to develop a healthier, more positive outlook - which can help relieve depression. Sometimes it’s helpful for families to be involved in therapy as well.
Antidepressant medication is another option for childhood depression treatment, especially when psychotherapy is unable to effectively treat mood symptoms. Untreated mood disorders in adolescents are associated with an increased risk of suicide. Some research also indicates a link between antidepressants and increased suicidal thoughts and behaviors in children being treated with these drugs, so it’s important for doctors to carefully weigh the risks and benefits before prescribing antidepressants to children. Still, for many kids, the benefits of antidepressants outweigh the risks.
Although the study was limited because data on usual care were not as robust as had been hoped, the researchers still concluded that SPARX “was at least as good as treatment as usual in primary healthcare sites in New Zealand, but would be cheaper and easier to disseminate.”
The study was supported by the New Zealand Ministry of Health.
The researchers reported no conflicts of interest.
Primary source: BMJ
Source reference: Merry SN, et al “The effectiveness of SPARX, a computerized self-help intervention for adolescents seeking help for depression: randomized controlled non-inferiority trial” BMJ 2012; DOI: 10.1136/bmj.e2598.