February 26, 2008
Teenagers whose initial drug treatment fails to combat
depression, which happens in four out of 10 cases, can be helped
by switching medicine and adding psychotherapy, a U.S. study
published on Tuesday said.
"The findings should be encouraging for families with a teen who
has been struggling with depression for some time," said Dr.
David Brent of the University of Pittsburgh who headed the
"Even if a first attempt at treatment is unsuccessful,
persistence will pay off. Being open to trying new
evidence-based medications or treatment combinations is likely
to result in improvement," he added.
The study, published in this week's Journal of the American
Medical Association, was conducted from 2000 to 2008.
It involved 334 patients aged 12 to 18 with major depression who
had not responded to two months of treatment with a selective
serotonin reuptake inhibitor or SSRI, a type of antidepressant.
The teens were variously switched to another SSRI such as
GlaxoSmithKline Paxil (paroxetine), Forest Laboratories Inc's
Celexa (citalopram) or Eli Lilly and Co's Prozac (fluoxetine);
given a different SSRI plus cognitive behavioral therapy, which
emphasizes problem-solving and behavior change; switched to
Wyeth's Effexor (venlafaxine), another type of antidepressant
called a serotonin and norepinephrine reuptake inhibitor or SNRI
that has been found good for treating drug-resistant depression
in adults; or switched to Effexor plus therapy.
The researchers found that about 55 percent of those who
switched to either type of medication and added therapy got
better, while 41 percent of those who switched to another
medication without therapy also responded.
There were no differences in their response to the two different
types of anti-depressant drugs used or any differences in the
way they were helped by the three different SSRIs involved.
"About 40 percent of adolescents with depression do not
adequately respond to a first treatment course with an
antidepressant medication, and clinicians have no solid
guidelines on how to choose subsequent treatments for these
patients," said Dr. Thomas Insel, director of the National
Institute of Mental Health, which paid for the study.
The results "bring us closer to personalizing treatment for
teens who have chronic and difficult-to-treat depression," he
While more than half of the teens in the study said they had
thoughts of suicide before the research began, the treatments
used appeared to have no impact on such thoughts, the
That finding, they added, is consistent with other studies that
have found that considering suicide does not necessarily subside
when the depression eases.
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