Successful treatment is key to helping those with depression live satisfying lives, but treatment does not always rapidly alleviate symptoms. In a recent study, a team of researchers, led by Dr. David Brent of the University of Pittsburgh, investigated the effect of different forms of treatment on teenagers with treatment-resistant depression. About 40% of depressed teens have depression that does not respond to initial treatment with medication. While there are no set methods regarding subsequent treatment approaches, their study, which appears in the Journal of the American Medical Association, indicates that the combination of medication and therapy works better for this group of patients than medication alone.
Using four treatment options, the study examined the effectiveness of medication compared with medication in addition to cognitive behavioral therapy (CBT), a common form of therapy that emphasizes problem solving as well as modifying thoughts and behaviors. Over 300 teens were involved in the study, all of whom had major depression and had not responded to previous treatment with an SSRI. Some of these participants were randomly assigned to switch to another SSRI— either paroxetine (Paxil), citalopram (Celexa), or fluoxetine (Prozac)— while others were randomly assigned to switch to another SSRI along with CBT. In addition to these treatment options, the researchers also randomly assigned some participants to take venlafaxine (Effexor) alone or in combination with CBT. A serotonin and norepinephrine reuptake inhibitor (SNRI), Effexor targets two of the brain’s neurotransmitters, serotonin and norepinephrine, while SSRIs' affects are targeted only at serotonin.
The treatment groups involving CBT were associated with higher rates of treatment response, with 55% of those who received CBT in addition to any medication seeing an improvement in symptoms. Only 41% of those who took medication without CBT experienced the same effect. There were no significant differences between the different types of SSRI or between SSRIs and the SNRI Effexor. As we have discussed previously, Effexor is associated with potentially severe side effects, especially during discontinuation of use, and this study supports the use of SSRIs rather than Effexor.
This study highlights therapy's important role in the treatment of depression, which, if left untreated, can have devastating consequences. More than half of the teens in this study were suicidal at the study's start, and 18 suicide attempts were made throughout the study's course. Treatment is crucial, and teens should be aware that if one treatment option does not have substantial effects, other options may offer better results. By studying different forms of treatment, researchers will gain a better understanding of how to improve the well-being of teens with depression, and someday we may even be better able to predict which form of treatment will most benefit a given patient.
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