Most depressed teens have stable therapy response
NEW YORK (Reuters Health) - Most adolescents with depression will achieve a sustained therapeutic response either during the initial phase of therapy or with continued treatment, according to a report in the Archives of General Psychiatry.
These conclusions are based on an analysis of data from 439 teenagers with major depression who were enrolled in the Treatment for Adolescents with Depression Study.
The patients were randomly assigned to drug treatment with fluoxetine (Prozac), cognitive behavioral therapy, both treatments, or placebo for 12 weeks, lead author Dr. Paul Rohde, from the Oregon Research Institute in Eugene, and colleagues note. This was followed by a 6-week continuation phase and then an 18-week maintenance period in which the patients underwent three sessions of cognitive behavioral therapy, drug treatment or both.
The main outcome measure, a sustained response, was defined as full response scores on two consecutive Clinical Global Impression-Improvement ratings.
Cognitive behavioral therapy is a short-term, time-limited treatment involving a collaborative effort between the patient and therapist. The method emphasizes the effect of thinking on feelings and that thoughts are the primary cause feelings and behaviors, not external forces. Therefore changing the way one thinks can improve feelings, even if external situations don't change.
Overall, 95 patients (39.3 percent) did not achieve a sustained response during the acute treatment phase. Patients in the cognitive behavioral therapy-only group were most likely not to achieve a sustained response -- 57.9 percent.
During the continuation and maintenance phases, sustained response rates were achieved by 80.0 percent of the combination group, 61.5 percent of the group receiving fluoxetine, and 77.3 percent of the cognitive behavioral therapy patients who did not initially have a sustained response.
By week 36, total sustained response rates of 88.4 percent, 82.5 percent, and 75.0 percent were noted in patients treated with combination therapy, fluoxetine, and cognitive behavioral therapy, respectively.
"Most adolescents with depression who had not achieved sustained response during acute treatment did achieve that level of improvement during continuation and maintenance therapies," the authors conclude.
The possibility," they add, "that cognitive behavioral therapy may help the subset of adolescents with depression who achieve early sustained response maintain their response warrants further investigation."
SOURCE: Archives of General Psychiatry, April 2008.
