Should Adolescent Patients With Depression Be Given Antidepressants? If So, Should It Be Only With Psychological Therapy?

Editor's Choice
Main Category: Depression
Also Included In: Psychology / Psychiatry;  Pediatrics / Children's Health;  Mental Health
Article Date: 20 Jul 2007 - 0:00 PDT

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The National Institute for Health and Clinical Excellence (NICE), UK, advocates that antidepressants should only be given to adolescent patients with depression if accompanied with psychological therapy. A new study published in www.bmj.com suggests that SSRI (selective serotonin reuptake inhibitor) treatment with CBT (cognitive behavioral therapy) will most probably not improve outcomes for adolescent patients with moderate to severe depression.

The study contradicts what NICE has in its guidelines.

In a BMJ Editorial this week, Philip Hazell, University of Sydney, a child psychiatrist expert, examines the evidence and explains what the implications might be for health care professionals treating adolescents with depression. Hazell says this is the 4th study to examine combination SSRI with CBT versus monotherapy for adolescent patients with depression.

A study carried out in the USA in 2004 found that fluotexine therapy in combination with CBT resulted in better outcomes than fluotexine alone in reducing depressive symptoms. A 2006 trial found that sertraline plus CBT was no better than monotherapy with sertraline.

Professor Hazell said this newest study shows that the trend is further away from the 2004 US trial. He added that variations in dose and treatment duration may play a factor in the differences. Even so, he indicates that combining CBT with an SSRI does not provide a significant advantage over monotherapy with an SSRI.

"What are the implications for health care professional treating adolescent patients with depression?" Hazell asks.

He says that, contrary to NICE guidelines, monotherapy with an SSRI is an adequate treatment for an adolescent patient with moderate to severe depression, especially in areas where getting CBT in time might be more difficult.

He added that monotherapy with an SSRI does not mean just writing a prescription. He noted that the participants in the study received a high level of clinical care, clinical reviews were frequent, and the monitoring of the benefit of treatment and adverse events was rigorous.

"Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial"
BMJ Volume 335 pp 142-6
http://www.bmj.com

Editorial:
"Depression in adolescents"
BMJ Volume 335 pp 106-7
http://www.bmj.com

Written by: Christian Nordqvist
Editor: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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