ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Adolescent and Young Adult Psychiatry
This article is part of the Research TopicMechanisms and Non-Pharmacological Interventions for Adolescent Mood DisordersView all 8 articles
Adjunctive Individual Meaning-Centered Psychotherapy Plus Protocolized Fluoxetine for Moderate-to-Severe Adolescent Depression
Provisionally accepted
Min Zhang*
Li-Li Sheng- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
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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.
Keywords: adolescents, Depression, Fluoxetine, Individual meaning-centered psychotherapy, PHQ-A
Received: 17 Nov 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Zhang and Sheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Min Zhang
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