Teen Depression: Try Therapy, Switch Medication
Two-Pronged Approach Helps Adolescents Who Don't Respond to Initial Antidepressant Alone
Teens switched to another medication -- either an SSRI or Effexor -- plus talk therapy improved more than those just switched to another medication. Nearly 55% of those given talk therapy and a new medication showed improvement in their depression, but improvement was seen in just 40.5% of those whose medication was switched but who did not get talk therapy.
No substantial differences were found between the two types of antidepressants. Overall, 47% of those on an SSRI improved while 48.2% of those on Effexor did.
Teens who were also on sleep medications, either prescription or over-the-counter, did not do as well as those not taking such medications, Brent says, but the reason is not clear.
The study was funded by the National Institute of Mental Health.
Message for Depressed Teens
For parents and teens, the advice is clear about what to do if the initial medication doesn't work, says Joan Rosenbaum Asarnow, PhD, professor of psychiatry at the University of California Los Angeles and a study researcher. "They should not only consider switching therapy but consider getting their child into cognitive behavioral therapy," she says. "The real finding here is that combining medication with cognitive behavioral therapy is what makes the difference in outcome."
"The most important advice is don't give up," adds Brent. "Even in the kids who only got a medication switch, 40% of them responded."
Other experts not involved in the study say the findings are encouraging for tough cases. The good news is that over time the majority of adolescents can and do respond to a combination of interventions, says David Fassler, MD, a clinical professor of psychiatry at the University of Vermont, Burlington. "The study underscores the importance of altering or modifying treatment based on an ongoing assessment of clinical response."
"This study confirms some things we already know," says Nada Stotland, MD, president-elect of the American Psychiatric Association and professor of psychiatry at Rush Medical College in Chicago. "And that is that many people need to try more than one antidepressant before they find the one that works, and that as a whole, no antidepressant is better than another for a whole population, but for individual persons, one is clearly better than another." The study also confirms the value of talk therapy, she says, which may be enough for mild cases of depression.