Drug + Therapy Combo Best for Teen Depression
Combined Approach Judged Better Than Drugs or Therapy Alone
WebMD News Archive
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
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
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."