More than one-third of teenagers with treatment-resistant depression -- many of whom had been depressed for more than two years -- became symptom-free six months after switching their medication or combining a medicine switch with cognitive behavioral therapy during a multicenter study led by UT Southwestern Medical Center researchers.
The study findings, available online and in a future edition of the American Journal of Psychiatry, found that teenagers who showed an improvement of symptoms after just three months into their new regimen were much more likely to show lasting beneficial effects.
"This study provides hope for parents and teenagers that persistence in seeking treatment will lead to recovery in some patients, especially if early treatment is aggressive," said Dr. Graham Emslie, professor of psychiatry and pediatrics at UT Southwestern and a principal investigator of the study. "Even after six months of treatment, however, about two-third of teenagers were still suffering from at least some symptoms of depression."
The 334 study participants ranged from 12 to 18 years of age. They exhibited traits of moderate to severe major depressive disorder, including thoughts of suicide. Historically, these types of patients have the worst treatment outcomes.
In February 2008, Dr. Emslie and colleagues first published work about these teenagers, who had failed to respond to a class of antidepressant medications known as SSRIs, or selective serotonin reuptake inhibitors. SSRIs, are the most common drug treatment for depression, although about 40 percent of teenagers on the drugs don't respond to the first treatment.
After three months, nearly 55 percent of the teens in Dr. Emslie's study improved when they both switched to a different antidepressant and participated in cognitive behavioral therapy, which examines thinking patterns to modify behavior. That study also found that after three months, about 41 percent of participants showed improvement after just switching to either a different SSRI or to venlafaxine, a non-SSRI type of depression medication.
Dr. Emslie and colleagues have now examined the six-month data from that study, and found that nearly 39 percent of participants who completed six months of treatment no longer had symptoms of depression. Those participants were more likely to have had lower levels of depression, hopelessness and anxiety at the beginning of the study.
Those who responded to the new regimen during the first three months were more likely to achieve remission, meaning minimal symptoms of depression or no symptoms at all. Many of those participants, who came from six sites across the country, responded during the first six weeks of treatment.
Current treatment guidelines suggest staying with a treatment for at least two to three months before trying another treatment.
"In light of our new findings, those guidelines may need to be revisited because these latest results suggest more aggressive treatment early on may improve outcomes," said Dr. Emslie, who also serves as chief of child and adolescent psychiatry at Children's Medical Center Dallas.
Dr. Emslie and his colleagues are continuing their studies on teenage depression and will use the new data to refine treatment guidelines.
Other UT Southwestern researchers participating in this study were Dr. Betsy Kennard, professor of psychiatry, and Taryn Mayes, faculty associate in psychiatry. Researchers at The University of Pittsburgh; the National Institute of Mental Health; Kaiser Permanente Center for Health Research in Portland, Ore.; UT Medical Branch in Galveston; the University of California, Los Angeles; and Brown University also participated in the research.
The study was funded by the National Institute of Mental Health and the Advanced Center for Interventions & Services Research for Early-Onset Mood & Anxiety Disorders at the Western Psychiatric Institute in Pittsburgh.
- Graham J. Emslie, Taryn Mayes, Giovanna Porta, Benedetto Vitiello, Greg Clarke, Karen Dineen Wagner, Joan Rosenbaum Asarnow, Anthony Spirito, Boris Birmaher, Neal Ryan, Betsy Kennard, Lynn DeBar, James McCracken, Michael Strober, Matthew Onorato, Jamie Zelazny, Marty Keller, Satish Iyengar, and David Brent. Treatment of Resistant Depression in Adolescents (TORDIA): Week 24 Outcomes. American Journal of Psychiatry, 2010; DOI: 10.1176/appi.ajp.2010.09040552
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