One treatment alternative might be internet-based psychodynamic psychotherapy (IPDT). Internet-based cognitive behavioural therapy (ICBT) has shown efficacy but a large number of depressed adolescents do not respond to treatment and there is a need for treatment alternatives to meet the needs of this large patient group. Untreated MDD in adolescence is related to further illness and adversity during the lifespan but there is a paucity of accessible and cost-effective treatments. Major depressive disorder (MDD) in adolescents is a leading cause of illness and disability worldwide. The study is registered at ISRCTN, ISRCTN12552584. A non-inferiority margin of Cohen's d=0♳0 was predefined. Primary analyses were based on an intention-to-treat sample including all participants randomly assigned.

The primary outcome was change in depression severity measured weekly by the QIDS-A17-SR. Both interventions comprised eight self-help modules delivered over 10 weeks on a secure online platform. Participants were randomly assigned to ICBT or IPDT. Adolescents who scored 9 or higher on the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR) in an initial online screening were contacted by telephone for a diagnostic assessment using the Mini International Neuropsychiatric Interview. Participants were recruited nationwide in Sweden through advertisements on social media, as well as contacts with junior and senior high schools, youth associations, social workers, and health-care providers. Eligible participants were 15–19 years old, presenting with a primary diagnosis of MDD according to DSM-5. In this randomised, clinical trial, we tested whether IPDT was non-inferior to ICBT in the treatment of adolescent MDD. The Lancet Regional Health – Western Pacific.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.

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