Lifting the Mood: Depressed teens benefit from combined therapy

Each year, approximately 1 in 20 teenagers experiences the anguish of major depression. Schoolwork and social life suffer as these youngsters grapple with feelings of helplessness and hopelessness, often topped by suicidal thoughts or behaviors.

There’s uplifting news for depressed teens, though. Many feel markedly better after completing a relatively brief course of treatment that includes both an antidepressant medication and talk therapy, according to a team led by psychiatrist John S. March of Duke University Medical Center in Durham, N.C.

In the largest-ever study of treatments for teen depression, this combination of drug and talk therapies alleviated the disorder’s symptoms in a larger proportion of youngsters than either treatment did alone, March and his coworkers report in the Aug. 18 Journal of the American Medical Association. The antidepressant-psychotherapy mix also showed superiority to placebo pills, the researchers say.

Few of the 439 depressed teens in the study reported that they had contemplated suicide or tried to kill themselves after beginning any of the treatments. No one carried out a suicide during the study.

March cautions, however, that the investigation wasn’t designed to address whether antidepressant drugs foster suicide (SN: 7/24/04, p. 51: Suicide Watch: Antidepressants get large-scale inspection).

The researchers recruited adolescents ages 12 to 17, all with a current diagnosis of major depression. About half the volunteers had received another psychiatric diagnosis as well, such as attention-deficit hyperactivity disorder. Participants were randomly assigned to receive 12 weeks of treatment with fluoxetine (Prozac), cognitive-behavioral therapy, a combination of the two, or placebo pills.

Cognitive-behavioral therapy for depression entails therapist-patient discussions about overturning negative ways of thinking, developing social skills, and setting goals to pursue pleasurable activities. In the new study, this talk treatment consisted of 15 sessions, each lasting about 50 minutes.

Cognitive-behavioral therapy exerted a complementary effect on drug treatment, the researchers say. After 12 weeks, substantial improvement had occurred for

71 percent of the youngsters given the combination treatment, compared with 61 percent of those given fluoxetine alone, 43 percent of those who received only the talk therapy, and 35 percent of those taking placebos.

Suicidal thoughts, present in nearly one-third of these depressed adolescents at the study’s start, declined substantially in each treatment group. Only the combination treatment proved superior to placebos in this respect.

More participants receiving fluoxetine alone cut themselves or attempted suicide than did peers in the other groups. However, a total of only 33 such incidents occurred in the study, too few for the researchers to draw any firm conclusion.

A 6-month follow-up of the adolescents will examine whether the benefits of cognitive-behavioral therapy alone become more apparent over time, as earlier studies of teens with less-severe depression have suggested.

“At this point, [March’s] study shows that fluoxetine works as a treatment for adolescent depression and that its effectiveness is increased by adding cognitive-behavioral therapy,” remarks psychiatrist Grayson S. Norquist, director of the division of services and intervention research at the National Institute of Mental Health in Rockville, Md. Norquist’s division funded the new investigation.