Most Depressed Teens Respond Well to Treatment
> 4/15/2008 3:11:16 PM

Can the parents of depressive teens attribute their conditions to a standard age-based chemical imbalance and trust patience to be the best medicine? Will professional treatment truly help, and how quickly do most affected teens respond? New research reveals that the majority of adolescents suffering from mood disorders benefit from treatment of some kind even when their symptoms are chronic or severe and that those who receive several months of regular therapy and/or medication fare far better on a symptomatic scale than those who get no treatment at all. The best results come from combined treatment plans that feature both medication and intensive therapy.

Unfortunately, most clinical research on long-term treatment for recurring depression has been performed on adult samples. Researchers from the Oregon Research Institute recruited 439 individuals aged 11-17 who'd been diagnosed with major depression and placed them on a 36-week treatment plan involving fluoxetine (Prozac) and Cognitive Behavioral Therapy (CBT). Patients were randomly assigned to placebo, fluoxetine, CBT or combination treatments, and their progress was recorded during interviews conducted at 6-week intervals by using the Children's Depression Rating Scale and a formal symptomatic improvement scale.

Researchers designed the study's variables to maximize the efficiency of their findings. After controlling for placebo subjects (who were notified of their status after 12 weeks and offered alternate treatments) and raising dosages for non-responsive individuals, they found that the majority of teens responded positively no matter what kind of plan they followed. Fluoxetine proved the most effective variable, improving symptoms to a greater degree than therapy alone, but the two treatments in combination predictably produced the study's highest recovery rates.

CBT is an intensive short-term therapy method in which patients meet with therapists one or more times a week and establish very clear, time-sensitive goals; this approach may prove a successful alternative to the open-ended personal psychotherapy model for some patients. We must emphasize that treatment models work differently on a case by case basis and that one must engage in a certain treatment plan before determining how well it will work for them. Subjects received 15 therapy sessions over the first 12 weeks of this study: some of the sessions involved the subject's parents either alone or with their child. After observing results for the first 12 weeks of treatment, researchers varied schedules based on how well subjects responded, and those whose improvements were most dramatic saw their therapists less often. In ideal cases, the CBT model works in this fashion, with progressively fewer sessions leading up to the end of the treatment plan.

Comprehensive results were encouraging: only 60% of participants registered any significant improvement after the study's first phase, but after 36 weeks, nearly 90% of the study group had achieved "sustained response," a condition defined by two consecutive positive response ratings on the 6-week surveys. CBT interestingly proved to be the least effective method of treatment - just over 40% of affected subjects had achieved sustained response after 12 weeks. This finding does not negate the value of CBT but throws its immediate efficiency into question when applied to major depression. Still, a considerable percentage of subjects did benefit from CBT, and recovery levels were far higher for individuals who received medication and therapy than those on fluoxetine alone.

The fact that fluoxetine and CBT were, respectively, the only medication and treatment approaches considered narrows the range of conclusions one can draw from the study. Studies involving a larger subject pool, more medications and more treatment plans must eventually be performed. And patient responses were graded on a 1-4 scale, but results obviously varied within these guidelines. Did slight improvements over 36 weeks add up to a "sustained response" as long as they lasted longer than 6 weeks? The scope of this study is somewhat limited, but its main point bears repeating: a majority of teens suffering from major depression would benefit significantly from treatment, whether therapeutic or pharmaceutical. Persistent symptoms of depression cannot be dismissed as signs of a typically temperamental adolescence. The sooner they seek treatment the better.

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