The Pharmaceutical Journal
Vol 280 No 7492 p269
8 March 2008

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Switch antidepressant and add CBT if first SSRI fails for teens

Adolescents with major depression who have not responded to initial treatment with a selective serotonin reuptake inhibitor may benefit from switching to another SSRI, or venlafaxine, and adding cognitive behavioural therapy (CBT), according to a study published in JAMA (2008;299:901).

Researchers randomised 334 patients (aged 12 to 18 years who had not responded to a two-month trial with an SSRI) to receive one of four strategies for 12 weeks: switching to a second SSRI; switching to a second SSRI plus CBT; switching to venlafaxine; or switching to venlafaxine plus CBT.

Results showed that CBT plus switching to another medicine improved clinical response compared with switching to another medicine alone (54.8 per cent versus 40.5 per cent; P=0.009). There was no significant difference between switching to another SSRI and switching to venlafaxine (47 per cent versus 48.2 per cent; P=0.83).

Patients who received venlafaxine experienced more skin problems than those who received an SSRI.