New research published in the Journal of the American Medical Association gives new hope to adolescents suffering from depression who have not responded to an initial treatment with selective serotonin reuptake inhibitor medications. The study, titled “Switching to Another SSRI or to Venlafaxine with or without Cognitive Behavioral Therapy for Adolescents with SSRI-Resistant Depression,” appeared in the Feb. 27 issue of JAMA.
The study found that for adolescents with depression who haven’t responded to an initial treatment with a SSRI, a class of antidepressant drugs, switching medications and adding cognitive behavioral therapy resulted in an improvement in symptoms compared to just changing medications.
“The findings from this study are important to clinicians, parents and depressed teenagers because it shows that trying another antidepressant and adding cognitive behavioral therapy can help to treat a teenager whose depression did not improve with the first antidepressant,” said Dr. Karen Dineen Wagner, a co-author of the study.
Wagner is vice chairwoman of the department of psychiatry and behavioral sciences and director of child and adolescent psychiatry at the University of Texas Medical Branch at Galveston. Lead author is Dr. David Brent of the University of Pittsburgh Medical Center.
The study’s authors concluded, “For adolescents with depression not responding to an adequate initial treatment with an SSRI, the combination of cognitive behavioral therapy and a switch to another antidepressant resulted in a higher rate of clinical response than did a medication switch alone. However, a switch to another SSRI was just as efficacious as a switch to venlafaxine and resulted in fewer adverse effects.” Venlafaxine is a selective serotonin and noradrenergic reuptake inhibitor.
“In this study of adolescents with moderately severe and chronic depression who had not responded to an adequate course of treatment with an SSRI antidepressant, switching to a combination of cognitive behavioral therapy and another antidepressant resulted in a higher rate of clinical response, 54.8 percent, than switching to another medication without CBT, 40.5 percent,” the authors wrote.
Depression is a common and damaging condition among adolescents. “Untreated depression results in impairment in school, interpersonal relationships, occupational adjustment, and increases the risk for suicidal behavior and completed suicide.
Therefore, the proper treatment of adolescent depression has profound public health implications for youth in this critical stage of development,” the researchers wrote.
Adolescents in the study, from 12 to 18 years, were in active treatment for major depressive disorder despite being treated with SSRI for eight weeks or longer. Participants were assessed with a diagnostic interview and laboratory tests. A total of 3,258 adolescents were prescreened with 334 included at the start of the study. The study was conducted from 2000 to 2006.
According to the authors, the CBT intervention emphasized cognitive restructuring and behavior activation, emotion regulation, social skills and problem solving. Parent-child sessions were also conducted to reduce critical remarks and to improve communication and support.
As many as 12 CBT sessions lasting 60-90 minutes each were held for each participant during the first 12 weeks.
- Switch to a second, different SSRI (paroxetine, citalopram, or fluoxetine).
- Switch to a different SSRI plus CBT.
- Switch to venlafaxine (an antidepressant shown in some studies to be superior to an SSRI in the management of treatmentresistant adult depression)
- Switch to venlafaxine plus CBT
Local clinical studies were conducted at UTMB’s Mood and Anxiety Center for Children and Adolescents in the Clear Lakearea. The center specializes in the study and treatment of depression, bipolar and anxiety disorders. The study is available at http://www.jama.amaassn. org/cgi/content/full/299/8/901.