Adding Therapy Helps Teens not Responding to SSRIs - JAMA
February 28th, 2008 | Email this to your FriendsFor adolescents with depression not responding to an initial treatment with a selective serotonin reuptake inhibitor (SSRI; a class of antidepressant drugs), switching medications and adding cognitive behavioral therapy resulted in an improvement in symptoms, compared to just changing medications, according to a study in the February 27 issue of JAMA.
Newswise — For adolescents with depression not responding to an initial treatment with a selective serotonin reuptake inhibitor (SSRI; a class of antidepressant drugs), switching medications and adding cognitive behavioral therapy resulted in an improvement in symptoms, compared to just changing medications, according to a study in the February 27 issue of JAMA.
Adolescent depression is a common, chronic, recurrent and impairing condition. “Untreated depression results in impairment in school, interpersonal relationships, occupational adjustment, and increases the risk for suicidal behavior and completed suicide. Therefore, the proper treatment of adolescent depression has profound public health implications for youth in this critical stage of development,” the researchers write.
Clinical guidelines for the treatment of adolescent depression recommend the prescribing of SSRI medications, psychotherapy, or both. While these treatments alone or in combination have been shown to be effective, at least 40 percent of adolescents with depression do not show an adequate clinical response to these interventions.
David Brent, M.D., of the University of Pittsburgh, and colleagues examined the relative efficacy of medication type, cognitive behavioral therapy (CBT), and the combination of both for the treatment of resistant adolescent depression. The randomized controlled trial, conducted from 2000-2006, included 334 patients, age 12 to 18 years, with a primary diagnosis of major depressive disorder who had not responded to a two-month initial treatment with an SSRI. For 12 weeks, participants were randomized to one of four treatments: switch to a second, different SSRI (paroxetine, citalopram, or fluoxetine); switch to a different SSRI plus CBT; switch to venlafaxine (a selective serotonin and noradrenergic reuptake inhibitor [SNRI], an antidepressant shown in some studies to be superior to an SSRI in the management of treatment-resistant adult depression); switch to venlafaxine plus CBT.
“In this study of adolescents with moderately severe and chronic depression who had not responded to an adequate course of treatment with an SSRI antidepressant, switching to a combination of CBT and another antidepressant resulted in a higher rate of clinical response [54.8 percent] than switching to another medication without CBT [40.5 percent]. There was no differential effect between switching to another SSRI [47.0 percent] or to venlafaxine [48.2 percent],” the authors write.
There were also no differential treatment effects on change in self-rated depressive symptoms, suicidal ideation, or on the rate of harm-related or other adverse events. There was a greater increase in diastolic blood pressure and pulse and more frequent occurrence of skin problems during venlafaxine than SSRI treatment.
“… the clinician should convey hope to the adolescent with depression and his or her family that, despite a first unsuccessful treatment for depression, persistence with additional appropriate interventions can result in substantial clinical improvement,” the researchers conclude.
(JAMA. 2008;299[8]:901-913. Available pre-embargo to the media at http://www.jamamedia.org)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
February 29th, 2008 at 5:40 am
I am so glad to see efforts being made in the treatment of adolescents. I taught in an adolescent program at one point. While the staff were tireless in their efforts to help these struggling young people, they often didn’t know which direction to turn. Studies such as these will help professionals in their pursuit of helping adolescents who are having a difficult time managing the transition from childhood to adulthood.
February 29th, 2008 at 5:46 am
I was somewhat taken aback when I read that most treatments for adolescents with major depression fail 40% of the time. That’s not good. I, too, am relieved to know that professionals in our field are taking a hard look at these numbers and making efforts to improve them.
February 29th, 2008 at 5:47 am
This is great news indeed. I have worked with adolescents for years in a therapy environment. Whenever I have spoken w/ the psychiatrist about changing medication, he’s always been reluctant. I’ll make a copy of the original study for him so that maybe we can move forward with some of our clients.
February 29th, 2008 at 9:33 am
I have a teenager struggling with depression. It seems that we’ve tried everything and nothing works. We’ve done everything this article suggests. Can anyone else offer a suggestion? It’s hard not to give up hope at this point.
April 2nd, 2008 at 3:15 pm
Do you find that teens are really open to talk therapy? It seems that the teens I am around want to have nothing to do with talking to adults, especially ones whom they perceive to be in postions of power over them.
May 4th, 2008 at 4:22 pm
My understanding is that the generally accepted treatment protocol for depression is that medication and psychotherapy are more effective than either alone. There is a substantial body of empirical research supporting the use of CBT with teens and depression (See, for example, material by Mark Reinecke at NW U).