|Depressed Adolescents Respond Best to Combination
Psychotherapy Combined with Antidepressant Medication Most Effective
A combination of psychotherapy and antidepressant medication appears
to be the most effective treatment for adolescents with major depressive
disorder — more than medication alone or psychotherapy alone, according
to results from a major clinical trial funded by the National Institutes
of Health's National Institute of Mental Health (NIMH). The study
was published in the October 2007 issue of the Archives of
The long-term results of the Treatment for Adolescents with Depression
Study (TADS) found that when adolescents received fluoxetine (Prozac)
alone or in combination with cognitive behavioral therapy (CBT)
over the course of 36 weeks, they recovered faster than those who
were receiving CBT alone.
However, taking fluoxetine alone appeared to pose some safety
concerns for the teens. During treatment, those taking fluoxetine
alone had higher rates of suicidal thinking (15 percent) than those
in combination treatment (8 percent) and those in CBT alone (6
percent), particularly in the early stages of treatment. This suggests
that while treatment with fluoxetine may speed recovery, adding
CBT provides additional safeguards for those vulnerable to suicide,
according to the researchers.
"Depression in teens is a serious illness that can and should
be treated aggressively," said NIMH Director Thomas R. Insel, M.D. "TADS
provides compelling evidence for families and clinicians that the
most effective way to treat depression in teens is with a two-pronged
approach. It reassures us that antidepressant medication combined
with psychotherapy is an effective and safe way to help teens recover
from this disabling illness."
Results at 36 weeks of treatment were consistent with those found
at 12 weeks [link to http://www.nimh.nih.gov/science-news/2004/combination-treatment-most-effective-in-adolescents-with-depression.shtml]
in the 439-person study, when NIMH reported that combination treatment
produced the greatest improvement in teenagers with major depression.
At 18 weeks (results not previously reported), combination treatment
still outpaced the other treatments with an 85 percent response
rate, compared to 69 percent for fluoxetine alone and 65 percent
for CBT alone. By 36 weeks, the response rate to combination treatment
still remained the highest (86 percent), while response rates to
fluoxetine and CBT essentially caught up, at 81 percent each.
"In the combination approach, the two treatments complemented
each other," said John March, M.D, MPH, of Duke University and
lead author of the study. "The fluoxetine can help dissipate the
physical symptoms of major depression relatively quickly, and CBT
can help patients develop new skills to contend with difficult,
Because the trial sample included a mix of younger and older teens,
both genders, substantial minority representation and variable
socioeconomic status, the TADS results can be applied broadly to
the adolescent population.
The National Institute of Mental Health (NIMH) mission is to reduce
the burden of mental and behavioral disorders through research
on mind, brain, and behavior. More information is available at
the NIMH website, http://www.nimh.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.