Teenagers with treatment-resistant depression have been offered a new option in a multicenter study led by UT Southwestern Medical Center researchers. The study reveals that six months of switching medication or combining a medicine switch with cognitive behavioural therapy helped more than one-third of teens with such a depression variant, many of whom had been depressed for more than two years, revealed a
The study found that teenagers who showed an improvement of symptoms after just three months into their new regimen were much more likely to show lasting beneficial effects.
"This study provides hope for parents and teenagers that persistence in seeking treatment will lead to recovery in some patients, especially if early treatment is aggressive. Even after six months of treatment, however, about two-third of teenagers were still suffering from at least some symptoms of depression," said Dr. Graham Emslie, professor of psychiatry and paediatrics at UT Southwestern and a principal investigator of the study.
The 334 study participants ranged from 12 to 18 years of age.
They exhibited traits of moderate to severe major depressive disorder, including thoughts of suicide. Historically, these types of patients have the worst treatment outcomes.
In February 2008, Emslie and colleagues first published work about these teenagers, who had failed to respond to a class of antidepressant medications known as SSRIs, or selective serotonin reuptake inhibitors.
SSRIs, are the most common drug treatment for depression, although about 40 percent of teenagers on the drugs don't respond to the first treatment.
After three months, nearly 55 percent of the teens in the study improved when they both switched to a different antidepressant and participated in cognitive behavioural therapy, which examines thinking patterns to modify behaviour.
The study also found that after three months, about 41 percent of participants showed improvement after just switching to either a different SSRI or to venlafaxine, a non-SSRI type of depression medication.
The researchers have now examined the six-month data from that study, and found that nearly 39 percent of participants who completed six months of treatment no longer had symptoms of depression.
Those participants were more likely to have had lower levels of depression, hopelessness and anxiety at the beginning of the study.
Those who responded to the new regimen during the first three months were more likely to achieve remission, meaning minimal symptoms of depression or no symptoms at all.
Many of those participants, who came from six sites across the country, responded during the first six weeks of treatment.
Current treatment guidelines suggest staying with a treatment for at least two to three months before trying another treatment.
"In light of our new findings, those guidelines may need to be revisited because these latest results suggest more aggressive treatment early on may improve outcomes," said Emslie.
The study has been published in a future edition of the American Journal of Psychiatry.