Exploring the effects of psychological interventions on clinical symptoms and executive control in adolescents with depression: a systematic review

Abstract

Introduction: Adolescent depression is characterized by severe clinical symptoms and executive dysfunction, but the multi-scale therapeutic mechanisms of non-pharmacological psychological interventions remain disputed. Objective: To systematically evaluate the regulation and remodeling effects of psychological interventions on clinical symptoms, higher cognitive functions, neurocircuits, and peripheral biological mechanisms in depressed adolescents. Method: Following PRISMA guidelines, we searched PubMed, Web of Science, and Cochrane Library (to June 2026). Literature screening, data extraction, and quality assessment (PEDro/MINORS scales) were performed independently. Results: Seventeen high-quality studies were included. (1) Combined psychological and pharmacological interventions accelerated acute symptom relief, reduced rumination and suicidal ideation, and restored social functioning. (2) Interventions enhanced executive control, shortened reaction times (Stroop/WCST/TMT), and improved working memory and verbal fluency. (3) Neuroimaging/EEG revealed synergistic limbic pathology reversal and prefrontal compensatory remodeling under cognitive tasks. (4) Interventions suppressed HPA axis hyperactivity, decreased interleukin-6 levels, and activated the BDNF pathway, facilitating bidirectional peripheral-central cross-talk. Conclusions: Combined psychological and pharmacological therapy effectively improves clinical symptoms and cognitive deficits in adolescents. Brain network remodeling operates via a dual-track synergistic model of limbic normalization and prefrontal compensation, proving evidence-based psychotherapy is a non-pharmacological prescription driving neuroplasticity.