Adding cognitive behavioral therapy enhances the safety of medication with depressed adolescents. Suicide is the major concern when treating depressed adolescents with selective serotonin reuptake inhibitors (SSRIs).
In a large randomized controlled trial (n=327) in the US with unmasked CBT and combination therapy, comparison was made between double blind placebo or fluoxetine for treatment of depressed adolescents. They were monitored during 12 weeks. After the 12 weeks treatment was unblinded.
At 12 weeks the response rate for combination therapy was 73%, for fluoxetine 62% and 48% for CBT.
After 18 weeks 85% for combination therapy, 69 for fluoxetine treatment, 65% for CBT. After 36 weeks 86% for the combination, 81% for fluoxetine and 81% for CBT.
Suicidal events were more common in patients receiving fuoxetine (14.7%) than combination therapy (8.4%) or CBT (6.3%).
Combination therapy in adolescents with moderate to severe depression is superior to medication or CBT alone.
See the related article with an opposite conclusion, Dr Shock is confused but thinking very hard, will be continued.
Related article on this blog:
For Adolescents no additional benefit of cognitive behavioural therapy with an antidepressant
Arch Gen Psychiatry. 2007 Oct;64(10):1132-43.
The Treatment for Adolescents With Depression Study (TADS): long-term
effectiveness and safety outcomes.
March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M,
McNulty S, Vitiello B, Severe J.