New Findings on Teens and Antidepressant Use

A major Duke-led study has shed new light on the best way to help the estimated 2 million American teenagers suffering from depression -- and more such guidance is on the way.

The findings of the Treatment for Adolescents with Depression Study (TADS), published in the October 2007 Archives of General Psychiatry, show that the combination of medication management with fluoxetine (Prozac) and cognitive behavioral therapy (CBT) improved depressive symptoms and reduced the level of suicidal thinking and behavior in adolescents better than medication or CBT alone.

"Depression among teenagers is a significant public health problem and there has been a tremendous need to identify treatments that work and are also safe," says lead investigator John March, MD, chief of child and adolescent psychiatry at Duke.

"While medication is very helpful, we found that combining medication with CBT produced the quickest improvement and, especially for suicidal thinking and behavior, a much improved outcome compared to medication alone."

March is also the principal investigator for the Child and Adolescent Psychiatry Trials Network (CAPTN), which is funded by the National Institute of Mental Health to conduct large, simple trials addressing questions of importance to doctors and patients.

The network has recently launched two new studies to help doctors identify which patients are good candidates for medication management and which patients might be most vulnerable to adverse events.

With this information, which is currently unavailable, doctors can steer specific patients toward drugs that will be helpful and away from those that might be harmful.

In the Antidepressant Safety in Kids (ASK) study the CAPTN team will follow 2,420 children and adolescents with a depressive disorder, anxiety disorder, obsessive-compulsive disorder, or eating disorder who are starting treatment with one of several commonly used antidepressants.

CAPTN investigators will gather information about the safety, tolerability, acceptability, and benefits of these medications along with a variety of patient, family, and environmental characteristics that may influence response to medication.

In a substudy entitled Pharmacogenomics of Antidepressant Response in Children and Adolescents (PARCA), the CAPTN team will examine selected gene variants that may be associated with an increase in benefits or in side effects, including drug-related suicidal events.