Reviews of cognitive

behavioural therapy (CBT) for adolescent depression have shown that it is effective and currently one of the main treatment options recommended in adolescents.2 8 Trials comparing CBT to either family therapy or supportive psychotherapy show that it is better at both improving mood and achieving remission.9 Seliciclib clinical trial It has also been shown to prevent depression in high-risk adolescent groups including the offspring of depressed adults.10 Since it has a low side effect profile it is an attractive alternative option for the treatment of adolescent depression. However, some studies have questioned its efficacy in young people with moderate to severe depression, questioning how powerful a treatment it is.7 11 The 1 year prevalence of depression in adolescents is about 2%.12 An area with a population of 300 000, such as that served by the York and Selby Community Adolescent Mental Health Service (CAMHS), would be expected to have at least 450 young people

with depression. Delivering CBT to this number of young people is far more resource intensive in terms of time than using medication. Many primary care doctors are referring all young people directly in to CAMHS rather than managing them in primary care, as they are reluctant to use medication and do not have the time or experience to deliver psychological therapy. Most primary care counsellors are not trained to counsel adolescents. This creates an additional pressure in CAMHS. Together with other service pressures, this leads to long waiting

lists in CAMH services in some areas. As a result, it is unlikely that individual CBT needs can be met from existing therapist resources.13 This therefore presents a number of challenges to services, including demands on clinical time, the potential development of waiting lists and issues about prioritisation of services. Given the affinity young people have with information technology, it may be that young people could be treated effectively and more widely using CCBT and at an Entinostat earlier stage in the evolution of their illness. The Improving Access to Psychological Therapies (IAPT) programme was introduced to improve availability of therapies and specifically mentions the use of CCBT in relation to depression. CCBT represents an alternative form of therapy delivery, which has the potential to enhance access to CBT and to provide a realistic alternative therapy or potentially a preventive intervention early in the course of depressive illness. Some argue that many adolescents, often reluctant to engage one to one with a therapist, may be more comfortable accessing computerised material or therapy. CCBT comes in many forms and can be directed at a range of conditions and age groups, but adequate research needs to be conducted to capture this broad range of possible new therapies.