Aug. 18, 2004 A new study from the Johns Hopkins Children's Center and 12 other medical centers shows the most effective treatment for adolescents with major depressive disorder is a combination of antidepressants and psychotherapy. Researchers say the study's findings indicate this combination treatment may be best for both improving depression and reducing the level of suicidal thinking in adolescents.
The multicenter Treatment for Adolescents with Depression Study (TADS) clinical trial, sponsored by the National Institute of Mental Health, is believed to be the first to examine the individual and combined effectiveness of the antidepressant fluoxetine (Prozac) and cognitive behavioral ("talk") therapy in depressed adolescents. The findings are published in the August 18th issue of the Journal of the American Medical Association.
Overall, combined antidepressant and talk therapy treatment yielded the best results, followed by antidepressants alone. However, talk therapy on its own was found to be no more effective than placebo, the researchers say.
"Until this study, there was limited evidence that proved antidepressants were appropriate for use in teenagers with depression," says John Walkup, M.D., a co-author of the study and a child and adolescent psychiatrist at the Johns Hopkins Children's Center. "Not only do the results support the use of antidepressants for depressed teens, but when used in conjunction with talk therapy, these medications actually provide teens with the best chance to alleviate their depression."
Controversy has surrounded the use of Prozac and similar medications (known as selective serotonin reuptake inhibitors) because of reports that they may lead a small number of teenagers and children to become suicidal. In the current study, researchers found that the level of suicidal thoughts, which had been present in 29 percent of the youths at the beginning of the study, decreased significantly regardless of the treatment received, with the combination of fluoxetine and talk therapy showing the greatest reduction. While no patients committed suicide during the study, there were seven cases of attempted suicide during the treatment phase of the study.
However, Walkup says the development of new suicidal thoughts after starting antidepressant medication is unusual. "As long as youths taking antidepressants are monitored closely by their physicians, I believe the benefits of antidepressants for depressed teens really outweigh the risks. Antidepressants can be a safe and effective treatment for teens with depression, a common condition that can be devastating if left untreated," he says.
During the first 12-week section of the study, 439 youths ages 12 to 17 with moderate to severe depression were randomly assigned to a treatment of either fluoxetine; cognitive behavior therapy, during which a therapist reinforces positive thought patterns and behavior; a combination of fluoxetine and talk therapy; or placebo pills.
Using common psychological scales to measure depression severity, researchers found that 71 percent of teens who received fluoxetine and talk therapy improved with treatment, compared with 60.6 percent who received fluoxetine alone, 43.2 percent who received talk therapy alone, and 34.8 percent who received a placebo treatment.
After 12 weeks, patients who were receiving fluoxetine, talk therapy, or a combination of both continued treatment for two more stages, while those who had not responded to placebos were offered the "active" treatment of their choice. However, results to date include only the first 12 weeks of treatment.
The study was led by John S. March, M.D., M.P.H., from Duke University Medical Center. Other TADS sites include: Johns Hopkins Children's Center, Carolinas Medical Center, Case Western Reserve University, Children's Hospital of Philadelphia, Columbia University, University of Nebraska, New York University, University of Chicago and Northwestern University, Cincinnati Children's Hospital Medical Center, University of Oregon, University of Texas Southwestern and Wayne State University.
For more information about the Johns Hopkins Children's Center, please visit: http://www.hopkinschildrens.org
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