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Drug + Therapy Combo Best for Teen Depression

Combined Approach Judged Better Than Drugs or Therapy Alone

Antidepressants and Suicide Risk continued...

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."

Study Provides Some Answers

Experts say the results of this study should provide some reassuring answers to parents and health-care providers about the relationship between antidepressants and suicide risk among adolescents, but several questions still remain.

In an editorial that accompanies the study, Richard M. Glass, MD, professor of psychiatry at the University of Chicago, says the biggest answer the study provides is that a combination of antidepressant and behavioral therapy is best for treating adolescents with major depression.

"In treating depression in general and in particular for adolescents, physicians can't just prescribe medication and then not see the patient for a long period of time; they really need to be carefully monitored," Glass tells WebMD.

Glass says the study also shows that it's important for both parents and health-care providers to be on the lookout for potentially dangerous side effects of antidepressant treatment, such as increases in irritability or suicidal thinking, which may emerge after treatment begins. He says more studies are needed to determine whether this is a temporary or lasting side effect of antidepressant use.

It's also unclear whether the results of this study apply to other SSRI antidepressants. Prozac is the only antidepressant approved to treat adolescents.

Glass says Prozac is unique in that it is long lasting, but its other effects on depression are similar to that found with other SSRIs.

"The weight of evidence right now would be that it is probably the right SSRI antidepressant to use for an adolescent who has a major depression because it had the approval and it has the studies that back up effectiveness," says Glass. "But whether that's going to hold up over time, I think that remains to be seen."

The study was supported by a grant from the National Institute of Mental Health and Eli Lilly and Co., which provided Prozac and a placebo under an educational grant to Duke University. Lilly is a WebMD sponsor.


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