Teens who have depression and also have substance abuse disorders seem to benefit from a combination of fluoxetine and cognitive behavioral therapy, according to an article in Archives of Pediatrics & Adolescent Medicine (JAMA/Archives), November issue. The researchers found the combination treatment was as effective with this group of teenagers as it was among teenagers with depression who did not have substance abuse disorders.
The authors explain “Adolescents with substance use disorders (SUDs) have higher rates of depression (15% to 24%) than adolescents in the general population. Comorbid [co-occurring] depression is also associated with more severe substance abuse, poorer drug treatment outcomes and higher relapse rates.”
Paula D. Riggs, M.D., University of Colorado Denver, and team carried out a randomized controlled trial with 126 teenagers who met the diagnostic criteria for major depressive disorder, lifetime conduct disorder and one or more substance abuse disorders (excluding tobacco). The patients were randomly selected to receive either 20 milligrams of fluoxetine per day, or a placebo each day. Both groups also received identical cognitive behavioral therapy.
Cognitive behavioral therapy is a type of psychotherapy which tackles the way you think and act rather than looking into past events. In the case of these teenagers the therapy focused on substance abuse rather than the depression.
The treatment period of this trial lasted 16 weeks. At the end of the period fluoxetine combined with cognitive therapy improved the patients’ scores on one of the two depression scales used significantly more than for the placebo group. The other depression scale showed no significant difference in substance abuse or conduct disorder symptoms between the two groups of patients.
The researchers wrote “(The results) indicate that, in the context of cognitive behavior therapy (substance abuse treatment), co-occurring depression may improve or remit without antidepressant pharmacotherapy. However, if depression does not appear to be improving early in the course of substance treatment, fluoxetine treatment should be considered, even if adolescents are not yet abstinent, with weekly monitoring of treatment adherence, substance use, adverse effects and target symptom response.”
“A Randomized Controlled Trial of Fluoxetine and Cognitive Behavioral Therapy in Adolescents With Major Depression, Behavior Problems, and Substance Use Disorders”
Paula D. Riggs, MD; Susan K. Mikulich-Gilbertson, PhD; Robert D. Davies, MD; Michelle Lohman, RN; Constance Klein, MSW; Shannon K. Stover, BA
Arch Pediatr Adolesc Med. 2007;161(11):1026-1034.
Written by׃ Christian Nordqvist