Furious Seasons

October 02, 2007

Prozac And CBT Help Treat Depression In Teens

From the new Archives of General Psychiatry comes a new medium term (nine months) study of depression in teens aged 12 to 17 years old. Patients were given either Prozac, Prozac plus CBT, or CBT only. Here's a rather chipper press account of the study.

Here are the results from the paper:

"Rates of response were 73% for combination therapy, 62% for fluoxetine therapy, and 48% for CBT at week 12; 85% for combination therapy, 69% for fluoxetine therapy, and 65% for CBT at week 18; and 86% for combination therapy, 81% for fluoxetine therapy, and 81% for CBT at week 36. Suicidal ideation decreased with treatment, but less so with fluoxetine therapy than with combination therapy or CBT. Suicidal events were more common in patients receiving fluoxetine therapy (14.7%) than combination therapy (8.4%) or CBT (6.3%)."

I'm sure different people will make different things out the suicidality data. I find it stunning that CBT-alone kicked Prozac's butt on that score. Of course, it's not there are tons of therapists out there practicing CBT with teens.

I'm more than a little surprised by the response rates in this study since similar studies in adults usually see far less robust response rates, often around 25 percent to 40 percent. But, then, perhaps youngsters bounce back much faster and harder than do adults--just like with bruises and broken bones.

Posted by Philip Dawdy at October 2, 2007 12:03 AM

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Comments

It looks like this study is suggesting that talk therapy alone has comparable long-term success and lower risk than Prozac. (The response rates seem high to me, too.)

As to whether CBT works better with depressed teenagers generally than other kinds of talk therapy would--well, that's a whole other conversation which this study doesn't address.

Posted by: Carol at October 1, 2007 11:54 PM

This is a good study, and I'm curious when This one is completed, considering I've spoken with the researcher in length and told him my daughter's activation on Zoloft story, while she was dx OCD/Bipolar at age 13. This new study is going to address more than depression with CBT vs. Zoloft, and looks to be a good group doing it, with Goodwin as Principal investigator. The person I spoke with told me they wanted to "prevent what happened to your daughter", by proving CBT works as gold standard treatment, which gave me much hope for other kids.

Posted by: Stephany at October 2, 2007 03:17 AM

Until we know what scale and how they were measuring response rates I wouldn't read too much into the absolute numbers. What is interesting is the relative success and as I've always "opined" the antidepressants do work in a certain window of time but their relative superiority during that initial phase usually declines pretty dramatically relative to any talk therapy the longer out one measures. Long term talk therapy usually wins out especailly on relapse measures (not even mentioned in this study) because if you stop the drugs or even if you don't you are going to have rebound big time. And docs are always calling "rebound" relapse when it is no such thing.

Posted by: Sara at October 2, 2007 06:17 AM

I don't get it. At 36 weeks the responce rate was 81% for unmedicated CBT and 86% for CBT plus Prozac. Yet the statistic for "suicidal thinking and behaviors" was almost 9% [more] for those teens on the Prozac versus the ones who were unmedicated.

So how does a 5% better response rate at 36 weeks come out as superior to a 9% risk of suicide. Sometimes I think people have lost all common sense.

Maybe the unmedicated CBT group could get their 'ratings' up from 81% to 86% by the addition of exercise, social support and Omega 3's. Anything has to be better than a statistic of almost one out of ten teens risking suicide.

Posted by: Rosie at October 2, 2007 07:23 PM