Teens with hard-to-treat depression may need continuous care and follow-up well beyond remission to keep the disorder under control. According to a NIMH-funded study published in the Journal of Clinical Psychiatry, teens with resistant depression have a significant chance for relapse even after achieving remission after 24 weeks of treatment.
In the study, teens whose depression did not respond to the first selective serotonin reuptake inhibitor (SSRI) were randomly assigned to one of the following four interventions:
- Switch to another SSRI—paroxetine (Paxil), citalopram (Celexa) or fluoxetine (Prozac);
- Switch to a different SSRI and combine it with cognitive behavioral therapy (CBT) —psychotherapy that focuses on problem-solving and behavior change;
- Switch to venlafaxine (Effexor), a different type of antidepressant with serotonin and norepinephrine reuptake inhibitor (SNRI) properties, or;
- Switch to venlafaxine plus CBT.
Once a full 24 weeks of treatment was over, the participants were released from the study and urged to continue treatment within their community. At 72 weeks, they were asked to return for an assessment.
Almost 40 percent of the teens who went on to complete 24 weeks of treatment gained remission, no matter which treatment they had been assigned. However, those teens who got better were more likely to have responded positively to treatment during the first 12 weeks.
Specifically, of the 334 participants, depressive symptoms had steadily decreased after week 24. About 61 percent achieved remission by week 72; however, many participants still had residual symptoms of depression at week 72, including fatigue, irritability and low self-esteem.
Teens who suffered with more severe depression from the beginning were less likely to get well. Those who responded to treatment early—within the first six weeks—had a much better chance of achieving remission. The assigned initial treatment did not seem to have an effect on who got well or how long it took.
Unfortunately, of the 130 teens who had achieved remission by week 24, 25 percent had relapsed by week 72. Ethnic minorities had a higher rate of relapse than whites.
Since more than one-third of the participants did not get well and the relapse rate was high as well, the study authors believe that more effective early treatments are needed. Furthermore, the higher relapse risk for ethnic minorities suggests that cultural factors may affect the course of depression and recovery in the long term, but the those factors remain unclear.