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    Drug + Therapy Combo Best for Teen Depression

    Combined Approach Judged Better Than Drugs or Therapy Alone

    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.

    Researchers say it's important to note that suicidal thinking among the adolescents studied decreased significantly among all four treatment groups from 29% overall to about 10%, and no completed suicides were reported.

    However, while antidepressants did not appear to have an effect on suicidal thinking, researchers did find a slightly increased risk of harmful behavior or actions among those taking Prozac.

    "Although the rates were low, kids who got [Prozac] either alone or in combination with CBT had a slightly increased rate of engaging in a harm-related adverse event," says March. "But adding CBT to the mix seems to buffer whatever that effect of [Prozac] has on proclivity to do something dumb, to engage in a harm-related impulsive behavior."

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