Teens, drugs, and sadness
Is a combo of pills and talking the best remedy for depression?
Walk into any high school classroom in the country today, and chances are at least one student there is suffering from a debilitating illness called depression. But when parents seek help for their children, they all too often find themselves frustrated by a lack of information on how best to treat the psychiatric disorder. Despite the high rate of depression in kids, remedies have for the most part been untested, so families of these kids have been left to grope in the dark.
Last week the darkness lifted a bit, when researchers made public the results of the first study to compare depression treatments in teenagers. The headline of their work: Nearly 3 in 4 of their young patients improved significantly with a combination of psychotherapy and Prozac, a popular brand of the antidepressant drug class known as SSRI s. Of the 439 teens who participated in the nationwide study, 61 percent of those receiving Prozac alone got better after 12 weeks of treatment.
Psychiatrists widely praised the findings as long-overdue and much-needed evidence in the confusing and increasingly controversial realm of depression treatment. The study is also an all-too-rare application of the controls that are standard in nonpsychiatric medical trials, in which participants are randomly assigned to different treatments and neither they nor their physicians know if they're getting the medication being tested or a dummy pill. "We now have solid clinical evidence that we can help kids significantly--and pretty quickly," says David Fassler, a child and adolescent psychiatrist in Burlington, Vt. "I think parents and physicians should be reassured."
Patient advocates also welcomed the findings. "It should take a lot of fear away from families," says Lydia Lewis, president of the Depression and Bipolar Support Alliance in Chicago. "The whole deal of patient empowerment is knowledge. You can't know if you're getting good treatment unless you know what good treatment is."
The teenagers who received the combination treatment got 15 sessions of cognitive-behavioral therapy, a widely used form of psychotherapy that focuses on recasting the negative thoughts typical of depression and increasing positive thoughts and actions. Sessions with parents and other family members were included. Previous studies have shown cognitive-behavioral therapy alone to be very effective in treating depression in adolescents, with about 60 percent showing improvement. But in this case, talk therapy alone helped just 43 percent of the time, a number not much different from the 35 percent who improved while taking placebo pills. John March, a child psychiatrist at Duke University Medical Center and lead researcher for the Treatment for Adolescents With Depression Study (known as TADS), whose results were published in last week's Journal of the American Medical Association, says the poor response to talk therapy may reflect the fact that the study included only patients with moderate to severe depression and that most study participants had been depressed for about a year.
The TADS research is also significant because it is one of the very few studies of antidepressants that were not financed by a drug manufacturer; instead, backing came from the National Institute of Mental Health. Antidepressants have come under increased scrutiny in the past year after it was revealed that pharmaceutical companies have failed to publish data suggesting increased rates of suicide in people taking SSRI antidepressants, the most commonly used form of the drugs. Teenagers and adults in their early 20s are far more likely to commit suicide than older adults. Each year, about 20 percent of adolescents contemplate suicide; by the end of high school, 1 in 10 of those has attempted suicide, with almost 2,000 succeeding each year. Half of those who die had major clinical depression, which is characterized by feelings of hopelessness, isolation, and irritability.
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