| Best Practice:Depression in Adolescents |
Fluoxetine combined with Cognitive Therapy shows highest level of improvement in
aolescents with depression
Medical Studies/Trials
Published: Thursday, 26-Aug-2004
http://www.news-medical.net/print_article.asp?id=4338
Adolescents with major depressive disorder show improvement after treatment that combines the
antidepressant fluoxetine (Prozac?) and cognitive behavioral therapy, according to the results of the
Treatment for Adolescents with Depression Study (TADS), published in the August 18 issue of the Journal
of the American Medical Association.
The TADS researchers said that major depressive disorder is common, with one in 20 teens affected at
varying levels of severity. Like other forms of depression, major depressive disorder has been associated
with increased risk of suicidal behavior and with completed suicide.
Major depressive disorder also has been linked to long-term psychosocial impairment in adulthood, said
Mark Reinecke, professor of psychiatry and behavioral sciences at Northwestern University Feinberg
School of Medicine, chief of the division of psychology and principal investigator on the TADS study at
Northwestern.
In the United States, 500,000 adolescents attempt suicide every year and 2,000 die as the result of their
injuries. According to 2001 statistics from the National Center for Injury Prevention and Control, suicide is
the third leading cause of death in Americans aged 10 to 24.
Thus, improvements in the treatment of major depressive disorder, which is quite common among
adolescents, should positively affect public health, TADS researchers said.
Researchers from the Feinberg School, Duke University Medical Center and 11 other academic and
community clinics participating in the TADS study evaluated the effectiveness of four treatments among
adolescents with major depressive disorder. The study included 439 patients with a primary diagnosis of
major depressive disorder who ranged from 12 to 17 years.
The participants were randomly assigned to 12 weeks of fluoxetine alone; cognitive-behavioral therapy
alone; cognitive behavioral therapy with fluoxetine; or placebo (sugar pill).
Compared with fluoxetine alone and cognitive behavioral therapy alone, treatment combining fluoxetine
with cognitive behavioral therapy was superior, said Reinecke.
Rates of response for fluoxetine with cognitive behavioral therapy were 71 percent; with fluoxetine alone,
61 percent; with cognitive behavioral therapy alone, 43 percent; and with placebo, 35 percent.
Clinically significant suicidal thinking, which was present in 29 percent of the sample at the beginning of the
study, improved significantly in all four treatment groups.
Fluoxetine with cognitive behavioral therapy showed the greatest reduction in suicidal thoughts. A little over
1 percent of 439 patients attempted suicide; there were no completed suicides.
The researchers also found treatment with fluoxetine alone elevated the risk for psychiatric adverse events.
"While fluoxetine did not appear to increase suicidal ideation, harm-related adverse events may occur
more frequently in fluoxetine-treated patients and cognitive behavioral therapy may protect against these
events," Reinecke said.
"Given the high prevalence, morbidity, and significant mortality associated with major depressive disorder,
the identification of depressed adolescents and provision of evidence-based treatment should be
mandatory in health care systems, Reinecke and co-researchers said.
Second, despite calls to restrict access to medications, medical management of major depressive disorder
with fluoxetine, including careful monitoring for adverse events, should be made widely available, not
discouraged.
Third, given incremental improvement in outcome when cognitive behavioral therapy is combined with
medication and, as importantly, increased protection from suicidality, cognitive behavioral therapy also
should be readily available as part of comprehensive treatment for depressed adolescents, the authors
strongly recommended.
The TADS results raise a mixture of questions and answers regarding the complicated issue of whether
antidepressant drug treatment prescribed to treat depression might increase the risk for depression's most
dangerous outcome, suicidal behavior, said an accompanying editorial.
This research was supported by a grant from the National Institute of Mental Health. Lilly Inc. provided
fluoxetine and matching placebo under an independent educational grant to Duke University.
aolescents with depression
Medical Studies/Trials
Published: Thursday, 26-Aug-2004
http://www.news-medical.net/print_article.asp?id=4338
Adolescents with major depressive disorder show improvement after treatment that combines the
antidepressant fluoxetine (Prozac?) and cognitive behavioral therapy, according to the results of the
Treatment for Adolescents with Depression Study (TADS), published in the August 18 issue of the Journal
of the American Medical Association.
The TADS researchers said that major depressive disorder is common, with one in 20 teens affected at
varying levels of severity. Like other forms of depression, major depressive disorder has been associated
with increased risk of suicidal behavior and with completed suicide.
Major depressive disorder also has been linked to long-term psychosocial impairment in adulthood, said
Mark Reinecke, professor of psychiatry and behavioral sciences at Northwestern University Feinberg
School of Medicine, chief of the division of psychology and principal investigator on the TADS study at
Northwestern.
In the United States, 500,000 adolescents attempt suicide every year and 2,000 die as the result of their
injuries. According to 2001 statistics from the National Center for Injury Prevention and Control, suicide is
the third leading cause of death in Americans aged 10 to 24.
Thus, improvements in the treatment of major depressive disorder, which is quite common among
adolescents, should positively affect public health, TADS researchers said.
Researchers from the Feinberg School, Duke University Medical Center and 11 other academic and
community clinics participating in the TADS study evaluated the effectiveness of four treatments among
adolescents with major depressive disorder. The study included 439 patients with a primary diagnosis of
major depressive disorder who ranged from 12 to 17 years.
The participants were randomly assigned to 12 weeks of fluoxetine alone; cognitive-behavioral therapy
alone; cognitive behavioral therapy with fluoxetine; or placebo (sugar pill).
Compared with fluoxetine alone and cognitive behavioral therapy alone, treatment combining fluoxetine
with cognitive behavioral therapy was superior, said Reinecke.
Rates of response for fluoxetine with cognitive behavioral therapy were 71 percent; with fluoxetine alone,
61 percent; with cognitive behavioral therapy alone, 43 percent; and with placebo, 35 percent.
Clinically significant suicidal thinking, which was present in 29 percent of the sample at the beginning of the
study, improved significantly in all four treatment groups.
Fluoxetine with cognitive behavioral therapy showed the greatest reduction in suicidal thoughts. A little over
1 percent of 439 patients attempted suicide; there were no completed suicides.
The researchers also found treatment with fluoxetine alone elevated the risk for psychiatric adverse events.
"While fluoxetine did not appear to increase suicidal ideation, harm-related adverse events may occur
more frequently in fluoxetine-treated patients and cognitive behavioral therapy may protect against these
events," Reinecke said.
"Given the high prevalence, morbidity, and significant mortality associated with major depressive disorder,
the identification of depressed adolescents and provision of evidence-based treatment should be
mandatory in health care systems, Reinecke and co-researchers said.
Second, despite calls to restrict access to medications, medical management of major depressive disorder
with fluoxetine, including careful monitoring for adverse events, should be made widely available, not
discouraged.
Third, given incremental improvement in outcome when cognitive behavioral therapy is combined with
medication and, as importantly, increased protection from suicidality, cognitive behavioral therapy also
should be readily available as part of comprehensive treatment for depressed adolescents, the authors
strongly recommended.
The TADS results raise a mixture of questions and answers regarding the complicated issue of whether
antidepressant drug treatment prescribed to treat depression might increase the risk for depression's most
dangerous outcome, suicidal behavior, said an accompanying editorial.
This research was supported by a grant from the National Institute of Mental Health. Lilly Inc. provided
fluoxetine and matching placebo under an independent educational grant to Duke University.
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