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Drug + Therapy Combo Best for Teen Depression

Combined Approach Judged Better Than Drugs or Therapy Alone

WebMD Health News

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 placebo alone.

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 Center.

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 minute sessions.

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 treatment.

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