The Pharmaceutical Journal
Vol 273 No 7313 p246
21 August 2004

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Effective therapy available for adolescents with depression

Adolescents with depression respond well to a combination of fluoxetine and cognitive behavioural therapy (CBT), a US study shows.

Researchers from Duke University medical centre, Durham, North Carolina, examined the effectiveness of each therapy alone, and used together, in 439 patients aged from 12 to 17 years diagnosed with major depressive disorder. Patients were assigned to 12 weeks of treatment — fluoxetine alone (10mg to 40mg per day), CBT alone (15 one-hour treatment sessions), CBT with fluoxetine, or placebo.

The researchers report that the response rate for fluoxetine with CBT was 71.0 per cent, 60.6 per cent for fluoxetine alone, 43.2 per cent for CBT alone and 34.8 per cent for placebo. However, CBT alone was not significantly better than placebo. Suicidal thinking, present in 29 per cent of patients at the start of the study, decreased among all treatment groups. Again, the greatest reduction occurred in the group receiving combination therapy. Although fluoxetine alone did not increase suicidal thoughts, it did seem to increase the risk for harm-related behaviours, say the researchers.

“While harm-related behaviours might be slightly more likely to occur in teenagers taking the antidepressant, CBT reduces harm-related behaviours to such an extent that the benefits of CBT outweigh the risks associated with the medication. We think this may be one of the reasons why the combination therapy proved to be more effective,” said John March, chief of child and adolescent psychiatry, and lead investigator on the study.

The researchers conclude: “Despite calls to restrict access to medicines, medical management of major depressive disorder with fluoxetine, including careful monitoring for adverse events, should be made widely available, not discouraged.” They also suggest that CBT should be readily available as part of comprehensive treatment for depressed adolescents (JAMA 2004;292:807).

Fluoxetine is the only antidepressant approved by the US Food and Drug Administration for use in children and adolescents. It is not currently licensed for this population in the UK.