Treatment of child depression most successful with Prozac and cognitive-behavior therapy combination

A new study by researchers at the UT Southwestern Medical Center at Dallas, have found that treatment of child depression was most successful when a combination of Prozac and cognitive-behavior therapy was applied.

Prozac is one of the world's most widely used anti-depressant drugs. It is prescribed to treat various kinds of depression, anxiety, and obsessive compulsive disorders. Cognitive Therapy (CBT) alters negative or harmful thought patterns that cause anxiety-provoking fears. The individual examines his/her feelings and learns to separate reasonable from unreasonable thoughts. As with Behavior Therapy, the individual is active in his/her recovery and acquires a sense of control.

The new research found that teenagers suffering from depression improved more with a combination of an antidepressant and cognitive-behavior therapy than they did when treated with either separately.

Results of a national, year long government-funded study in which UT Southwestern Medical Center at Dallas researchers participated also showed that depressed teens treated only with cognitive-behavior therapy did little better than teens given placebos. Cognitive-behavior therapy is a form of psychotherapy that emphasizes the role of thinking in creating subsequent feelings and behaviors.

The study, designated the Treatment for Adolescents with Depression Study (TADS), is the first to directly compare psychotherapy and medication treatment for teenagers, said Dr. Graham Emslie, professor of psychiatry and director of UT Southwestern’s child and adolescent psychiatry division.

Conducted at 13 academic and community centers around the country, the study examined the effectiveness of four treatments for adolescents with major depressive disorder: treatment with fluoxetine whose brand name is Prozac; treatment with cognitive-behavior therapy only; treatment with a combination of the two; and use of a placebo. The study included 439 patients ages 12 through 17.

“For moderate to severely depressed adolescents, a combination of medication and cognitive-behavior therapy is the most effective treatment,” said Dr. Emslie, who holds the Charles E. and Sarah M. Seay Chair in Child Psychiatry. “In this particular age group, treating with therapy alone is not an effective alternative.

“Recent controversies over using antidepressants in adolescents bring up the issue of assessing risk versus benefit. If there were non-medication therapies that worked as well as antidepressants for adolescents, then there would be plausible treatment alternatives. This study shows that not to be the case.”

Study results showed a 71 percent improvement in teens receiving Prozac and therapy together, as compared with a 60 percent improvement rate in subjects given Prozac only, 43 percent for those in therapy only and 35 percent who took placebos. Results were measured by standardized guidelines used to evaluate symptoms of depression.

“As physicians, we need to be careful about monitoring medications in teens,” Dr. Emslie said. “People should be concerned about using medications appropriately. But they also should realize that antidepressants are an important part of treatment for depression in adolescents.”

Major depressive disorder affects 5 percent of American teens. Depression also contributes significantly to teen suicides and suicidal behavior, with suicide the third leading cause of death in adolescents. More than half-million teens attempt suicide each year, with 2,000 – almost half suffering from major depression – dying. Depression in teens also is a major risk for depressive disorder, suicide and long-term psychosocial impairment in adulthood.

There were no suicides in the TADS study. The number of suicide attempts was too small to analyze statistically, and there was little difference in the number of attempted suicides in each of the four groups examined, Dr. Emslie said.