Teen Depression: Try Therapy, Switch Medication
Two-Pronged Approach Helps Adolescents Who Don't Respond to Initial Antidepressant Alone
Feb. 26, 2008 -- Depressed teens who don't respond well
to the first antidepressant medication they are prescribed
do improve if they are switched to a different antidepressant medication and
also offered "talk" therapy, according to a new study.
The combination -- switching medications and offering talk therapy -- works
better than simply changing medications, the researchers found, although
switching medications alone also offers improvement.
"This validates our clinical hunch about what to do with these
kids," says study researcher David Brent, MD, professor of psychiatry at
the University of Pittsburgh. "Which is, if the medicine isn't working,
switch it, and if they aren't getting cognitive behavioral therapy (talk
therapy), you should add it."
About 40% of teens with clinical depression don't respond
well when treated initially with commonly prescribed antidepressants known as
SSRIs (selective serotonin reuptake inhibitors), experts say. How to help these
adolescents has been an ongoing challenge. Results of the new study, published
in The Journal of the American Medical Association, are expected to
offer important guidance.
Depressed Teens Study: Four Options
From 2000 to 2006, researchers from the University of Pittsburgh and five
other universities and clinics nationwide evaluated 334 clinically depressed
teens, aged 12 to 18, who had not responded to a two-month initial treatment
with an SSRI antidepressant. They assigned the teens to one of four groups for
One group was switched to another SSRI antidepressant, such as Paxil, Celexa, or Prozac. Another group was
switched to a different SSRI antidepressant than they took initially, plus
given talk therapy. A third group was switched to the antidepressant Effexor, which is known as an
SNRI (serotonin and norepinephrine reuptake inhibitor). The fourth group got
Effexor plus talk therapy.
Effexor was selected, Brent says, because "at the time we designed the
study there were studies in adults that found Effexor was more effective for
difficult-to-treat depression." The teens studied had been clinically
depressed for two years, Brent says.
Up to 12 sessions of talk therapy were offered during the study, and some
sessions included family members.
The researchers evaluated improvements in depression with commonly used
scales and interview questions.
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.