Prozac and therapy are best for depressed teenagers

PHOENIX - In the midst of a worldwide debate on whether depressed children should be treated with antidepressant drugs like Prozac, a landmark government-financed study has found that Prozac helps teenagers overcome depression far better than talk therapy. But a combination of the two treatments, the study found, produced the best result.

The study, sponsored by the National Institute of Mental Health, was the first to compare psychotherapy and drug treatment for adolescents. Statistically, the researchers found, talk therapy was no more effective in reducing the teenagers' depression than treatment with dummy pills. But when combined with drug treatment, psychotherapy appeared to provide added benefit and to reduce the risk of suicide.

The findings are likely to serve as a balm to psychiatrists, pediatricians and others who increasingly prescribe antidepressants to teenagers and children. Millions take the drugs.

Experts said the study is notable for its size and for the fact that it was carried out without drug company money. Data on the effects of antidepressants in adolescents is in short supply. Most studies of the question have been small trials sponsored by pharmaceutical companies and have failed to show that the drugs are effective for depressed teenagers.

"This study should put to rest doubts about whether these drugs work in teenagers with severe depression," said Dr. Graham Emslie, a professor of psychiatry at the University of Texas Southwestern Medical Center and an author of the study, which was presented at a meeting of psychiatric drug researchers recently.

Still, the findings are unlikely to resolve the controversy over whether Prozac and similar drugs lead a small number of teens and children to become suicidal.

Such concerns led the federal Food and Drug Administration (FDA) to warn earlier this year that patients taking the drugs should be watched closely for signs of suicide or other harmful behavior in the first weeks of therapy. The FDA is amid a reanalysis of suicidal events in drug-company trials of antidepressants in children and teenagers. British drug regulators have banned the use of all but Prozac in those under the age of 18.

The government study, called the Treatment for Adolescents with Depression Study, or TADS, involved 439 teenagers ages 12 to 17 who were suffering from moderate to severe depression. The adolescents were randomly assigned to receive Prozac, a form of talk therapy known as cognitive behavioral therapy, placebo pills or a combination of Prozac and talk therapy, for a period of 36 weeks.

The researchers collected data on the subjects for a year, but they have so far only analyzed information from the first 12 weeks of the study. Of the teenagers recruited for the study, 378 completed the first 12 weeks of treatment. Their mean age was 15. Depression levels were measured using several common psychological scales.