BMJ study on adolescent depression contradicts NICE advice
A study on adolescent depression published in the BMJ (2007;335:142) contradicts National Institute for Health and Clinical Excellence (NICE) guidelines.
The study examined the effects of selective serotonin reuptake inhibitors
(SSRIs) with and without cognitive behavioural therapy (CBT) and found
that there is little or no advantage in combined treatment.
The adolescent depression antidepressant and psychology trial (ADAPT)
studied 208 young people aged 11–17 years, recruited from mental
health services in Manchester and Cambridge. Of these, 103 patients were
randomly selected to undergo SSRI treatment and routine clinical care,
while the other 105 were randomised to an SSRI, routine care and CBT.
The trial took 12 weeks, followed by a 16-week maintenance period.
The finding that both groups reported equal improvement challenges guidance
published by NICE that recommends SSRIs are only administered together
with psychological therapy.
A previous trial, the treatment of adolescent depression study (TADS)
indicated that an SSRI, fluoxetine, in combination with CBT, yielded
better results than fluoxetine alone, and possibly reduced suicidal behaviour.
This informed the NICE guidelines, which advise combined treatment, with
monotherapy considered a last resort.
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