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 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 Aug. 18 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, 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, of Duke University
Medical Center. In addition to Johns Hopkins Children's
Center, TADS sites are 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, go to
www.hopkinschildrens.org.