Switching medications and continuing treatment could help teens with severe depression

May 17, 2010

More than one-third of teenagers with treatment-resistant depression - many of whom had been depressed for more than two years - became symptom-free six months after switching their medication or combining a medicine switch with cognitive behavioral therapy during a multicenter study led by UT Southwestern Medical Center researchers.

The study findings, available online and in a future edition of the , found that teenagers who showed an improvement of symptoms after just three months into their new regimen were much more likely to show lasting beneficial effects.

"This study provides hope for parents and teenagers that persistence in seeking treatment will lead to recovery in some patients, especially if early treatment is aggressive," said Dr. Graham Emslie, professor of psychiatry and pediatrics at UT Southwestern and a principal investigator of the study. "Even after six months of treatment, however, about two-third of teenagers were still suffering from at least some symptoms of depression."

The 334 study participants ranged from 12 to 18 years of age. They exhibited traits of moderate to severe major , including thoughts of suicide. Historically, these types of patients have the worst treatment outcomes.

In February 2008, Dr. Emslie and colleagues first published work about these teenagers, who had failed to respond to a class of antidepressant medications known as SSRIs, or . SSRIs, are the most common drug treatment for depression, although about 40 percent of teenagers on the drugs don't respond to the first treatment.

After three months, nearly 55 percent of the teens in Dr. Emslie's study improved when they both switched to a different antidepressant and participated in , which examines thinking patterns to modify behavior. That study also found that after three months, about 41 percent of participants showed improvement after just switching to either a different SSRI or to venlafaxine, a non-SSRI type of depression medication.

Dr. Emslie and colleagues have now examined the six-month data from that study, and found that nearly 39 percent of participants who completed six months of treatment no longer had symptoms of depression. Those participants were more likely to have had lower levels of depression, hopelessness and anxiety at the beginning of the study.

Those who responded to the new regimen during the first three months were more likely to achieve remission, meaning minimal symptoms of depression or no symptoms at all. Many of those participants, who came from six sites across the country, responded during the first six weeks of treatment.

Current treatment guidelines suggest staying with a treatment for at least two to three months before trying another treatment.

"In light of our new findings, those guidelines may need to be revisited because these latest results suggest more aggressive treatment early on may improve outcomes," said Dr. Emslie, who also serves as chief of child and adolescent psychiatry at Children's Medical Center Dallas.

Dr. Emslie and his colleagues are continuing their studies on teenage depression and will use the new data to refine treatment guidelines.

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5 / 5 (2) May 17, 2010
Though anti-depressants are certainly indicated for some cases of depression, cognitive behavioral therapy (alone or in conjunction with medication) has been shown to be effective at treating depression in numerous scientific studies. Parents should educate themselves about depression and the available treatments before deciding on the best course of action for their child. Depression is a serious mental health issue and needs to be treated with the same care that a physical ailment would be. A great website, sponsored by the American Psychological Association is www.effectivechildtherapy.com. It offers free, honest information for parents about symptoms and treatments for depression and other childhood disorders.
not rated yet May 18, 2010
"...to venlafaxine, a non-SSRI type of depression medication.." Venlafaxine IS an SSRI, but it is usually referred to as an 'atypical' SSRI as it also effects reuptake of Noradrenaline and, to a lesser degree, Dopamine
not rated yet May 18, 2010
Venlafaxine exhibits primarily SSRI action at lower dosages. At 150-200mg/day you pick up the noradrenalinergic effects and the same is true of dopamine at around 300-350mg/day.

This study has too many variables to be anything more than a gentle push in a general direction.
not rated yet May 18, 2010
It seems there is legitimate concern over the use of venlafaxine in adolescents with major depression. From Wikipedia:

"Venlafaxine is contraindicated in children, adolescents and young adults. According to the FDA analysis of clinical trials[21] venlafaxine caused a statistically significant 5-fold increase in suicidal ideation and behavior in persons younger than 25. In another analysis, venlafaxine was no better than placebo among children (7–11 years old) but improved depression in adolescents (12–17 years old). However, in both groups, hostility and suicidal behavior increased in comparison to those receiving a placebo.[22] In a study involving antidepressants that had failed to produce results in depressed teenagers, teens whose SSRI treatment had failed who were randomly switched to either another SSRI or to venlafaxine showed an increased rate of suicide on venlafaxine.(con't)
not rated yet May 18, 2010

"Among teenagers who were suicidal at the beginning of the study, the rate of suicidal attempts and self-harm was significantly higher, by about 60%, after the switch to venlafaxine than after the switch to an SSRI. [23]"

Seems that venlafaxine use in depressed adolescents should be very carefully considered, especially in light of other, less risky, alternatives(meds, therapy, etc).

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