Antidepressant Maintenance Treatment in Adolescents
The findings of a recent study with a small sample size (n=22) suggests a possible benefit of maintenance treatment with sertraline over placebo. After an acute treatment phase of 12 weeks responders were followed during the continuation phase of 6 months. The patients who maintained response were randomized to either placebo or continued on sertraline.
None of the 9 subjects in the placebo group maintained response (no recurrence) during the 52-week randomization phase. In contrast, 5 of 13 subjects (38%) in the sertraline group remained well.
A lot of controversy has been raised around the use of antidepressants for adolescents suffering from depression. It was suggested that antidepressants increase the risk of suicide in adolescents as can be read in:“On the Antidepressant Suicide Link”. Conflicting results were published on the combination of cognitive behavioral therapy and antidepressants for depression in adolescents. You can read about a post describing beneficial effects and a post without this beneficial effect of the combination.
Fear of decreasing use of antidepressants for depression in adolescents causing increased suicides could not be demonstrated in the United States nor in The Netherlands.
Efficacy of antidepressants for depression in adolescents has been a topic of debate and posts like: SSRIs effective in adolescents?, Antidepressants have Limited Efficacy in Juvenile Depression.
This maintenance study however suggest that maintenance treatment may be beneficial to youth with major depressive disorder if they have responded and stayed well during follow-up (6 months). This is comparable to the maintenance treatment in adults. In adults continued treatment with antidepressants after acute response is critical in preventing recurrence in patients with major depression.
Limitations
Small sample size, Survival analyses found no significant differences between the groups. The acute phase was an open label trial. Lack of the inclusion of a specific suicide instrument
Amy Cheung, Vivek Kusumakar, Stan Kutcher, Elyse Dubo, Jane Garland, Margaret Weiss, Alex Kiss, Anthony Levitt (2008). Maintenance Study for Adolescent Depression Journal of Child and Adolescent Psychopharmacology, 18 (4), 389-394 DOI: 10.1089/cap.2008.0001
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November 10, 2008 @ 6:28 pm
n=22 is really too small to be meaningful I’m afraid. But I can believe this result, because we know from Geddes et. al. that antidepressant maintenance is highly effective in people who initially responded. So if they work acutely, they’ll probably also work long-term.
November 10, 2008 @ 7:35 pm
It is very small, but sample size in these kind of trials (maintenance) mostly have the disadvantage of few patients. Maintenance or even continuation treatment in adults with antidepressants as published in Kupfer & Frank is based on small sample size. Better small than none at all (that rhymes;))
November 11, 2008 @ 3:01 am
Fair enough! Small studies are better than no studies – most of the time.
By the way, you might be interested in something I’ve just posted to my blog, about ECT:
Shock and Cure
I suspect it’s going to get some flak – so any backup would be appreciated. (Also, if you’d care to add me to your blogroll, that’s always appreciated too!)