# Integrating Dialectical Behaviour Therapy Into the Treatment of Adolescent Depression: A Retrospective Study

## TL;DR

This study shows that combining dialectical behavior therapy with sertraline improves depression and emotional regulation in adolescents more effectively than either treatment alone.

## Contribution

The novel contribution is demonstrating the superior efficacy of combining DBT with sertraline for adolescent depression compared to monotherapies.

## Key findings

- Combined DBT and sertraline treatment showed the fastest reduction in depression scores initially.
- The sertraline-only group experienced a rebound in depression scores by week 24, unlike DBT-containing groups.
- Combined treatment significantly increased positive emotional regulation strategies more than either treatment alone.

## Abstract

Globally, the prevalence of depression among adolescents is on the rise, posing serious societal problems. Dialectical behaviour therapy (DBT) and selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are two commonly employed therapeutic approaches that have shown good clinical outcomes. This study aims to investigate the therapeutic effects of DBT with or without sertraline on adolescent depression.

This retrospective analysis reviewed 88 cases of adolescent depression treated at our hospital and compared them with 60 healthy adolescents. The patients with depression were divided into three groups: sertraline alone, DBT alone, and combined DBT and sertraline (DBT+sertraline) treatment. In the Sertraline-only and DBT+sertraline groups, sertraline was administered orally for a continuous period of 24 weeks. In the DBT-only and the DBT+sertraline groups, DBT treatment lasted for 13 weeks, followed by an observation period of another 11 weeks. DBT treatment efficacy was evaluated using the Hamilton Depression Rating Scale (HAMD) and the Cognitive Emotion Regulation Questionnaire (CERQ) at baseline and after 5, 9, 13 and 24 weeks of treatment.

Results showed that all three treatment modalities significantly reduced HAMD scores (p < 0.001, η = 0.749). The combined treatment group achieved the fastest reduction in HAMD score at the initial treatment stage. Whilst the Sertraline group showed a pronounced reduction by Week 13, it later exhibited a rebound in scores at 24 weeks, unlike the DBT-containing groups. In terms of emotional regulation strategies, CERQ scores indicated that DBT+sertraline significantly increased positive emotional regulation strategy scores, followed by DBT alone (DBT+sertraline vs DBT, p < 0.001), whilst the sertraline-alone group had the smallest increase (DBT+sertraline vs sertraline, p < 0.001) This pattern was particularly pronounced in the Positive Reappraisal subscale. Negative emotional regulation strategy scores were significantly reduced across all treatment groups, especially for the Self-blame item, with the largest reduction observed in the DBT+sertraline group, followed by the DBT alone (DBT+sertraline vs DBT, no significance) and sertraline-alone (DBT+sertraline vs sertraline, p < 0.001) groups.

This study's findings demonstrate that DBT and sertraline can improve emotional regulation abilities and effectively alleviate symptoms of depression in adolescents. In particular, superior outcomes were observed in the combined treatment group compared to the individual treatment groups. These findings aim to provide guidance and reference for clinicians, mental health professionals, policymakers and families of patients.