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Combination of drugs and therapy found best for depressed teenagers
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Gardiner Harris NYT
Wednesday, June 2, 2004
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PHOENIX, Arizona In the midst of a worldwide debate on whether depressed children should be treated with antidepressant drugs like Prozac, a landmark government-financed study has found that Prozac helps teenagers overcome depression far better than talk therapy. But a combination of the two treatments, the study found, produced the best result.
The study, sponsored by the National Institute of Mental Health, was the first to compare psychotherapy and drug treatment for adolescents. Statistically, the researchers found, talk therapy was no more effective in reducing the teenagers' depression than treatment with dummy pills. But when combined with drug treatment, psychotherapy appeared to provide added benefit and to reduce the risk of suicide.
The findings should be reassuring to psychiatrists and pediatricians who prescribe antidepressants to teenagers and children. Millions take the drugs. Experts said the study was notable for its size and for the fact that it was carried out without drug company money.
"This study should put to rest doubts about whether these drugs work in teenagers with severe depression," said Dr. Graham Emslie, a professor of psychiatry at the University of Texas Southwestern Medical Center and an author of the study, which was presented here Tuesday at a meeting of psychiatric drug researchers.
Still, the findings are unlikely to resolve the controversy over whether Prozac and similar drugs lead a small number of teens and children to become suicidal.
Such concerns led the Food and Drug Administration to warn earlier this year that patients taking the drugs should be watched closely for signs of suicide or other harmful behavior in the first weeks of therapy. The agency is conducting a reanalysis of suicidal events in drug company trials of antidepressants in children and teenagers. Britain has banned the use of all but Prozac in those under the age of 18. The government study, called the Treatment for Adolescents with Depression Study, involved 439 teenagers aged 12 to 17 who were suffering from moderate to severe depression. They were randomly assigned Prozac, a form of talk therapy known as cognitive behavioral therapy, placebo pills or a combination of Prozac and talk therapy, for 36 weeks.
Using one measurement scale, the researchers found that after 12 weeks, 71 percent of the subjects who received Prozac and talk therapy responded well to treatment, compared with 61 percent of those who received Prozac alone, 43 percent of who received talk therapy alone and 35 percent of those who received a placebo treatment. By another measure, talk therapy alone fared no better than treatment with dummy pills.
The researchers found that patients became much less suicidal no matter which treatment they had. No patient committed suicide during the trial. But the risk of a suicide attempt among teenagers given Prozac was twice that of those who did not receive it.Dr. John March, a professor of psychiatry at Duke University, said the findings showed Prozac's benefits for depressed teens far outweighed its risks.
March acknowledged that the controversy about suicide and antidepressant therapy was far from resolved.
The New York Times
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