Adjunctive individual meaning-centered psychotherapy plus protocolized fluoxetine for moderate-to-severe adolescent depression.

OBJECTIVE

To determine whether individual, adapted Meaning-Centered Psychotherapy (IMCP), delivered alongside protocolized fluoxetine, improves depressive symptoms and related outcomes in adolescents with moderate-to-severe depression.

METHODS

Among 168 adolescents with DSM-5-TR depressive disorder and Patient Health Questionnaire-9 modified for Adolescents (PHQ-A) ≥10, all receiving protocolized fluoxetine, participants were randomized to IMCP+TAU or TAU; the IMCP group completed seven weekly 60-minute sessions. The primary outcome was PHQ-A; secondary outcomes were the Zung Self-Rating Anxiety Scale (SAS), Clinical Global Impressions - Severity and - Improvement (CGI-S/CGI-I), Children's Global Assessment Scale (CGAS), Rosenberg Self-Esteem Scale (RSES), and Meaning in Life Questionnaire - Presence and Search subscales (MLQ-Presence/Search). Serious adverse events (SAEs) and adverse events (AEs) were recorded throughout the 12-week study period.

RESULTS

Across 12 weeks, the IMCP group showed earlier and larger reductions in depressive symptoms (PHQ-A) than TAU, with advantages evident by week 4 and maintained at weeks 8 and 12; severity distributions shifted more toward milder categories in IMCP. Anxiety (SAS) declined in both groups, with greater improvement in IMCP. Clinician ratings reflected the same pattern: IMCP achieved lower illness severity (CGI-S) and better early improvement (CGI-I), and greater functional gains (CGAS) throughout follow-up. Self-esteem (RSES) rose more in IMCP. Meaning in life-Presence (MLQ-Presence) increased more with IMCP, while Search (MLQ-Search) changed minimally and similarly across groups. Neither group experienced SAEs, and AE frequencies were low and did not differ meaningfully between groups.

CONCLUSIONS

Adjunctive IMCP with standardized fluoxetine produced greater 12-week improvements than TAU in symptoms, clinician ratings, functioning, self-esteem, and felt meaning, supporting IMCP as a feasible and effective adjunct.