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Combination Therapy Best Addresses Teen Depression

According to the most recent report from the Treatment for Adolescents with Depression Study (TADS) in the October issue of Archives of General Psychiatry, using cognitive-behavioral therapy (CBT) and antidepressants together has both short- and long-term advantages beyond either of the treatments alone.

Over a 36-week time period, research randomly assigned 327 adolescents 12 to 17 years old with a DSM-IV major depression diagnosis to one of the following treatments: 111 to CBT, 109 to fluoxetine therapy and 107 to combination therapy.

Medication was initially prescribed at 10mgs dosage per day and adjusted according to patient reaction and need thereafter. The sample of patients undergoing CBT participated in 15 one-hour sessions in the first 12 weeks and afterwards less frequently according to patient response.

While patients prescribed with fluoxetine (Prozac) experienced accelerated improvement, this group had twice the risk of suicidal events compared to the other two groups. There were no completed suicides in the TADS, but notably, the combined therapy seemed to temper suicidal ideations.

"Starting patients on fluoxetine improved functioning and lowered illness burden quickly, while adding CBT seems to have had an additional effect on modulating suicide," said Stan Kutcher, M.D., the Sun Life Financial Chair in Adolescent Mental Health in the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia -- who was not involved in the trial.

Initially, researchers witnessed improvements in 73 percent of patients receiving combination therapy, 62 percent of those receiving fluoxetine only, and 48 percent of those receiving CBT only. Retaining approximately 74 percent of the patients at the end of the 36-week test period, positive response rates reached 86 percent for combination therapy, 81 percent for fluoxetine, and 81 percent for CBT.

"The benefit of combination therapy derives from the swifter initial action of the drug linked with the longer term effects of CBT," said lead author John March, M.D., M.P.H., professor and chief of child and adolescent psychiatry in the Department of Psychiatry and Behavioral Science at Duke University.

Authors of the study believe the findings can be applied to a broad range of patients since the study sample included young and older adolescents of both genders from various socioeconomic backgrounds and a minority representation reflective of the U.S. population. Researchers will implement post-trial patient follow-ups for the next year and continue to monitor functional outcomes of the participants as they transition into young adulthood.

ABSTRACT: The Treatment for Adolescents With Depression Study (TADS): Long-term Effectiveness and Safety Outcomes