Drugs plus therapy works best for depressed teens

CHICAGO, Oct 1 (Reuters) - A combination of drugs and therapy was more effective at treating depressed teens than either drugs or therapy alone, U.S. researchers said on Friday, offering a new model for treating troubled teens.

Some 86 percent of teens who took the antidepressant Prozac and underwent therapy for 36 weeks responded to treatment.

The study, which appears in the Archives of General Psychiatry, also confirms that medication alone raises the risk of suicidal thoughts and actions in teens.

But pairing the Eli Lilly and Co


drug Prozac, also known as fluoxetine, with cognitive behavioral therapy or CBT -- a type of therapy that focuses on present feelings rather than past events -- mitigated this risk and offered the speediest way to improved health in this at-risk group.

"The combination is more effective and works more quickly that either cognitive behavioral therapy or fluoxetine alone, and there is the enhanced safety when you have the CBT incorporated into it," said Dr. Mark Reinecke of Northwestern University's Feinberg School of Medicine in Chicago, who worked on the study.

"Fluoxetine accelerates the improvement process, and CBT safeguards against the risk of suicide," Reinecke said in a telephone interview. "We now know what works for at least 80 percent of our patients."

Twelve-week results from this same study, released in 2004, showed antidepressants increase the risk of suicidal thoughts and actions in teens, fueling a review of drugs that ended in in a "black box" warning on antidepressant use in teens, the strongest warning issued by the U.S. Food and Drug Administration.

Reinecke said this warning had the unintended effect of reducing the use of antidepressants in teens. Teen suicide rates climbed 8 percent in 2004, reversing earlier declines, according to the Centers for Disease Control and Prevention.

The latest results from the federally funded study dubbed Treatment for Adolescents with Depression Study confirmed a higher risk of suicidal thoughts and actions in teens on antidepressants, but showed how they might be safely used.

The study involved 327 patients between 12 and 17 with major depressive disorder who were followed over 36 weeks. About one third got fluoxetine alone. Another third got CBT alone. And the remaining third got a combination.

Teens taking fluoxetine alone had about double the thoughts of suicide, compared with either the combination group or the group given therapy alone. None of the patients in the study committed suicide.

Dr. John March of Duke University, who led the study, said the benefits of combining medicine and cognitive therapy outweigh the risk for suicide. Cognitive therapy also works on its own, but takes longer, he added.

"If you put the whole thing together, the combination of fluoxetine and therapy is the best treatment," March said.

"We finally now have some evidenced-based guidelines for how we should approach depression in teenagers," Reinecke said.

Depression affects about 5 percent of all adolescents and is the leading cause of suicide.