Depression in youth is linked to serious psychosocial consequences, including academic underachievement, social withdrawal, and suicidality. While various types of interventions exist (i.e., psychotherapy, pharmacotherapy, and combined approaches), most meta-analyses compare psychotherapies only to control conditions. Consequently, less is known about how psychotherapies perform relative to pharmacotherapy, combined treatments, or other psychotherapies. This study aims to address that gap through a systematic review and meta-analysis of depression psychotherapy RCTs targeting children and adolescents. In total, 96 RCTs were identified and included in the analysis. 

The results showed a medium effect favouring psychotherapy when compared to control conditions (g = -0.46), with effect sizes varying significantly by control type: larger against waitlists than against care-as-usual or other controls. CBT showed a small, non-significant advantage over other therapeutic approaches (g = -0.19). Evidence comparing psychotherapy to pharmacotherapy or combined treatment was mixed and, crucially, too limited to draw firm conclusions, with only two RCTs available in each comparison. High heterogeneity and significant publication bias indices warrant caution when interpreting the results.