Combination of Medication and Therapy Works Best for Teens
> 10/2/2007 12:01:34 PM

A longitudinal study of adolescents suffering from Major Depressive Disorder has revealed, unsurprisingly, that a combined course of medication and talk therapy is the most successful approach to countering teen depression and thoughts of suicide both in the immediate future and the long-term sense.

The ongoing project, performed by researchers at Duke University and considered the most comprehensive study of adolescent depression yet performed, could help to negate the overblown debate regarding the propensity of adolescents on SSRI's to commit suicide. Beginning in 1999, researchers followed the development of more than 600 patients aged 12-17 who had suffered from depression for one year or more; the patients were randomly assigned to one of four treatment options: Prozac alone, placebo pills, weekly Cognitive Behavioral Therapy sessions, or a combination of Prozac and regular CBT.

After 12 weeks of treatment, 75% of patients receiving medication and therapy reported that their conditions were "much better" or "very much better," with improved moods and few or no thoughts of suicide. The number for those on Prozac alone was 2 out of 3, and after four months the entire group acheived the same degree of success - a rare feat for a study involving placebo trials. By nine months, an encouraging 8 out of 10 teens had largely or completely overcome their depression. Perhaps the most surprising find: those who received only the CBT treatment fared no better, by their own estimation, than those in the placebo group.

And yet, adding further fuel to the anti-pharmaceutical fire, thoughts of suicide were slightly higher among those who took only the SSRI. Lest we add to the unproductive confusion regarding this issue's recent coverage in various media forums, we should reinforce the fact that the statistical discrepancy in question speaks more about the persuasive influence of therapy than any kind of damage wrought by anti-depressants. By helping patients better regulate their daily lives and teaching them (slowly and painfully) to resist self-defeating thoughts and behaviors, therapy heightens the positive influence of the anti-depressants; hence the far higher and faster percentages of recovery among those receiving both forms of treatment as opposed to therapy alone, which may not be enough to counter the influence of Major Depressive Disorder in the initial stages of treatment.

The study's main conclusion is that combination therapy should be enthusiastically recommended for teens suffering from moderate to severe depression. Unfortunately, establishing a constructive relationship with a CBT therapist is far more difficult than acquiring a Prozac prescription. Psychiatrists and general practictioners need to make teens and their parents aware of the many beneficial treatments that extend beyond a pill every morning. If CBT therapy is not common in a given locality, the online treatment option can be explored - it grows more common each day, and with time will prove to be an indispensable aspect of treatment for many of the millions affected by depression. With some combination of medication and therapy, the vast majority of teens can temper their depression and return to living their lives with confidence and satisfaction. The options are there; they just need to be passed along.

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