Prozac plus counseling best for depressed teens

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For depressed adolescents, Prozac plus cognitive-behavioral counseling is more effective than either treatment alone for relieving symptoms and reducing suicidal thinking, new research shows.

Based on “remarkably strong and consistent findings,” Prozac is recommended for depressed adolescents, provided that they’re closely monitored for side effects, according to the report in this week’s Journal of the American Medical Association.

Because cognitive behavioral therapy (CBT) combined with medication is even more beneficial, increasing protection from suicidal thoughts, “CBT also should be readily available as part of comprehensive treatment for depressed adolescents,” the investigators add.

The Treatment for Adolescents with Depression Study (TADS) included 439 depressed teenagers recruited at 13 clinics across the US. The subjects were randomly selected to receive Prozac, CBT, both therapies, or inactive “placebo” pills for 12 weeks, lead author Dr. John S. March, at Duke University Medical Center in Durham, North Carolina, and colleagues note.

Compared with the placebo group, only patients treated with both Prozac and CBT were more likely to experience an improvement in their depression. Although Prozac or CBT alone could improve depression, the chances of this happening were not that much different from what was seen with placebo.

The authors also found that Prozac plus CBT was better than the other treatments at reducing suicidal thoughts. Prozac alone was the least effective in this regard, but there was no evidence that the drug increased the risk of suicidal thoughts—a topic of controversy in recent months.

However, Prozac use was associated with an increase in harm-related events, such as self-injury by cutting, aggressive thoughts, or action against another person or property.

In a related editorial, Dr. Richard M. Glass, Deputy Editor of JAMA, cautions that treatment of depression “typically requires more than a brief visit for prescription of medication.”

“Rather, it requires careful assessment and monitoring in the context of an ongoing patient-physician relationship,” he writes, plus “empirically validated psychotherapy.”

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