SSRI-Resistant Teens Helped By Change in Regimen

February 26, 2008

Chronically depressed adolescents who fail to respond to a first selective serotonin reuptake inhibitor (SSRI) may be successfully treated with cognitive behavioral therapy and a switch in antidepressant medication, a combination that appears to be more efficacious than switching medications alone, researchers report in the Feb. 27 issue of the Journal of the American Medical Association.

TUESDAY, Feb. 26 (HealthDay News) -- Chronically depressed adolescents who fail to respond to a first selective serotonin reuptake inhibitor (SSRI) may be successfully treated with cognitive behavioral therapy and a switch in antidepressant medication, a combination that appears to be more efficacious than switching medications alone, researchers report in the Feb. 27 issue of the Journal of the American Medical Association.

David Brent, M.D., of the University of Pittsburgh, and colleagues in the National Institute of Mental Health-funded Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study randomly assigned 334 adolescents aged 12 to 18 to switch to one of the following four groups: a second, different SSRI (paroxetine, citalopram or fluoxetine, 20-40 mg); a different SSRI plus cognitive behavioral therapy; venlafaxine (150-225 mg); or venlafaxine plus cognitive behavioral therapy.

The researchers found that response rates were significantly higher in adolescents who received cognitive behavioral therapy plus a switch to either medication regimen than switching medications alone (54.8 percent versus 40.5 percent). Although they found no difference in response rates associated with venlafaxine and a second SSRI (48.2 percent versus 47 percent), they noted that venlafaxine was more likely to cause side effects such as skin problems, higher pulse rate and increased diastolic blood pressure.

The authors write that clinicians "should convey hope to the adolescent with depression and his or her family that, despite a first unsuccessful treatment for depression, persistence with additional appropriate interventions can result in substantial clinical improvement."

Many of the researchers on this study report receiving prior research grants or consulting fees from pharmaceutical companies that manufacture antidepressants.

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