Typically when a teenager isn’t responding to an antidepressant, their doctor’s first thought is to try a different antidepressant. But new research suggests that adding a type of psychotherapy — cognitive-behavioral therapy (CBT) — to the treatment switch results in better outcomes for the patient.
The study also found no differences in effectiveness between commonly prescribed selective serotonin reuptake inhibitors (SSRI) antidepressants (such as Paxil or Prozac) and venlafaxine (Effexor).
“Despite the high percentage of non-response and the serious consequences of persistent depression in this age group, until now there have been no empirical studies to guide clinicians regarding the management of this population. With these results, doctors now have the guidelines to properly respond to and treat their adolescent patients,” said David A. Brent, M.D., one of the researchers at the University of Pittsburgh School of Medicine responsible for the study.
Dr. Brent and his team of researchers created a six-site, National Institutes of Mental Health funded study, the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA), in order to focus on non-response to an SSRI, rather than on non-response to psychotherapy, because SSRIs have been the predominant method of treatment for adolescent depression.
The study involved 334 depressed 12 to 18 year olds who were followed for a period of 12 weeks. The effectiveness of four treatment strategies was evaluated in patients who had not responded to a two-month initial treatment with an SSRI. Those treatments included a switch to a second, different SSRI such as paroxetine, citalopram or fluoxetine; a switch to a different SSRI in addition to CBT; a switch to venlafaxine; or a switch to venlafaxine in addition to CBT. Results showed CBT plus a switch to either medication regimen showed a higher response rate than a medication switch alone. However, there was no difference in response rate between venlafaxine and a second SSRI.
The researchers chose to compare SSRIs with venlafaxine, an SNRI (serotonin and norepinephrine reuptake inhibitor), because prior studies on adults have shown that venlafaxine is more effective than an SSRI in managing treatment-resistant depression. And, unlike similar studies on adolescent depression, TORDIA included teens who were actively suicidal so that the study would mirror real-world treatment situations to ensure its findings would be readily applicable to community settings.
“These findings should be encouraging for families with a teen who has been struggling with depression for some time,” said Dr. Brent. “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.”
Adolescent depression is a fairly common, chronic, recurrent and impairing condition that accounts for a substantial proportion of physical injuries and premature death in teens. Untreated depression results in problems in school and interpersonal relationships and increases the risk for suicidal behavior. Therefore, proper treatment has profound public health implications for youth in this critical stage of development.
Cognitive behavioral therapy is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel.
The study was published in the current issue of the Journal of the American Medical Association.
Source: Journal of the American Medical Association