Drug + Therapy Combo Best for Teen Depression
Combined Approach Judged Better Than Drugs or Therapy Alone
Aug. 17, 2004 -- Treating depressed teenagers with a
combination of antidepressants and psychotherapy is better than either
treatment approach alone, according to a major new study.
The results also suggest that combining antidepressant
treatment with talk therapy may help alleviate some of the potentially harmful
or suicidal behaviors that may be associated with antidepressant use.
Researchers found more teenagers with major depression got
relief and were effectively treated for their condition with a combination of
Prozac, one of a class of commonly used antidepressants known as SSRIs, and
cognitive behavioral therapy than with antidepressants, psychotherapy, or
The study also showed that the combination of Prozac and
cognitive behavioral therapy produced the greatest reduction in suicidal
thinking among the different treatment approaches. However, researchers found
an increase in harm-related adverse events associated with antidepressant use
that may be tempered by behavioral therapy.
"The greatest benefit at the lowest risk is not to use
medication alone but to use it in combination with cognitive behavioral
therapy," says researcher John March, MD, MPH, of Duke University Medical
Earlier this year, the FDA warned parents and health care
providers that children and adolescents taking antidepressants should be
closely monitored for worsening depression and suicidal thinking, especially at
the start of treatment. FDA officials are currently reviewing data on a
possible link between antidepressant use and suicide risk in children and is
expected to discuss their findings at a meeting next month.
Comparing Teen Depression Treatments
Researchers say antidepressants are widely used in treating
children and adolescents with depression, but previous studies have produced
mixed results on the benefits vs. risks associated with these medications.
In this study, published in the Aug. 18 issue of The Journal
of the American Medical Association, researchers compared the effectiveness
of four different treatment approaches in 439 children and teens aged 12-17
with major depression. The children were randomly assigned to receive a
combination of Prozac and behavioral therapy, behavioral therapy alone, Prozac
alone, or a placebo (sugar pill) for 12 weeks.
The cognitive behavioral therapy (CBT) used in the study was a
skills-oriented treatment that is based on changing negative thought patterns
and increasing active, positive behaviors. The treatment consisted of 15, 50-60
At the end of the treatment period, researchers found 71% of
the patients responded to the combination depression treatment compared with
61% of those on Prozac alone, 43% of those who received behavioral therapy, and
35% of those on placebo.
"The take-home message is that the initial treatment of
choice for kids with major depression should be the combination of [Prozac] and
cognitive behavioral therapy," March tells WebMD.
Antidepressants and Suicide Risk
Last year, the FDA and health officials in the U.K. issued
safety warnings regarding another SSRI, Paxil, after a study showed an
increased risk of suicidal thinking and attempts among children taking the
drug. But officials say it is not yet clear whether
antidepressants increase the risk of suicidal thinking and behavior in
depressed persons who inherently face a higher risk of suicide without adequate