Psychotherapy, Pharmacotherapy, and Their Combination for Adolescents with Major Depressive Disorder: A Meta-Analysis Nikita Singh and John Reece Department of Psychology, RMIT University, Bundoora, Victoria, Australia This meta-analysis aims to inform clinical practice of treatment strategies for adolescents with major depressive disorder (MDD). The efficacy of three em- pirically validated treatments was compared to determine the most effective treatment. These were: cognitive-behavioural therapy (CBT), selective serotonin reuptake inhibitor (SSRI) pharmacotherapy, and combination CBT and SSRI ther- apy. Inclusion criteria required studies to report a reliable and valid pre- and post-treatment measure and adequate data for Hedge’s g effect size to be cal- culated. Forty-nine studies meeting the above inclusion criteria were found and included in the analysis. Although all three treatment strategies were found to be effective, analysis revealed no significant difference in treatment outcome among CBT, SSRI, and combination therapy. An investigation of moderator variables revealed months to follow-up to significantly influence the relation- ship between treatment type and treatment outcome. Given that CBT has no side effects, is more cost effective, and is equally as effective as SSRI therapy and combination therapy, the current study makes a strong case for CBT as a first-line treatment strategy for adolescents with MDD. ■ Keywords: major depressive disorder, adolescents, treatment, CBT, SSRI, combination therapy Major depressive disorder (MDD) is a common, recurrent, and debilitating mental illness. MDD affects individuals of all ages, and early onset MDD during childhood and adolescence has been found to be highly recurrent, with 30% of cases extending into adult life (Usala, Clavenna, Zuddas, & Bonati, 2007). Mid- to late-adolescence, in particular, appears to be a critical period for the onset of MDD, and there is a rise in prevalence from 3% in childhood to 8% during adolescence (March et al., 2007). Given the vulnerability of adolescents to MDD (Reinecke & Simons, 2005), research has focused on identifying empirically validated treatments for this group. Combination psychosocial therapy with pharmacotherapy has been recommended for the treatment of adolescents with MDD (McDermott et al., 2010), following evidence to support the efficacy of combination therapy in the adult population (Pampallona, Bollini, Tibaldi, Kupelnick, & Munizza, 2004). Despite the established superiority of combination therapy over CBT and SSRI monotherapies in the adult population, Received 24 March 2013; Accepted 23 November 2013 Address for correspondence: Nikita Singh. Email: nikita_s@hotmail.com The Australian Educational and Developmental Psychologist Volume 31 | Issue 1 | 2014 | pp. 47–65 | c  Australian Psychological Society Ltd 2013 | doi 10.1017/edp.2013.20 47