ombination of cognitive behavioral therapy and anti-depressant medication is the best treatment option for teens with major depressive disorder. The Treatment for Adolescents with Depression Study followed a diverse group of 654 teens for 36 weeks. One group took the anti-depressant fluoxetine (brand name Prozac), another group engaged in cognitive behavioral therapy with a therapist, and yet another group was given both treatments. After 18 weeks, 69 percent of the teenagers taking fluoxetine alone and 65 percent of those participating in cognitive behavioral therapy alone showed improvement. In contrast, 85 percent of those receiving both treatments showed improvement after the 18 weeks. After 36 weeks, the difference in outcome for the three treatments diminished somewhat, with 86 percent of those in the combination therapy showing improvement compared to 81 percent of those in the other single-treatment groups.Another significant finding of the study was that combining cognitive behavioral therapy with the anti-depressant also significantly reduced the rate of suicidal thinking in the teens. Although anti-depressants have helped many people with depression, they have ironically also been blamed for increasing the rate of suicidal thoughts, especially in teens. Most SSRIs (selective serotonin reuptake inhibitors) like fluoxetine are now required to come with “black-box” labels warning of the effect, and it is for this reason many doctors are wary of prescribing this type medication to teens even though it has been shown to be effective in most people. This side-effect was seen in the study with 15 percent of the teens in the fluoxetine-only group reporting suicidal thoughts. However, only 8 percent of the teens in combination therapy reported suicidal thoughts, which was closer to the 6 percent of teens in the cognitive behavioral therapy alone. This suggested to the study’s authors that the cognitive behavioral therapy in some way mitigated the negative effects of the fluoxetine and that the two treatments complemented each other well.
One thing I am left wondering about this study is why it did not include a control group given no treatment or a placebo. It would have been interesting to see whether or not there was a large difference between teens given a placebo plus cognitive behavioral therapy differed much from the ones given the combination treatment described above. In addition, they
could have given a “placebo” therapy in combination with the fluoxetine to see if it was the actual cognitive behavioral therapy that produced the changes or just the act of consistently talking with a trusted adult. Also, since many people naturally recover from depression over time, it would have been interesting to compare the results of the study with a group of teens given no treatment. However, I can see how the risk of the teens harming themselves if not treated would outweigh the benefit of including a no-treatment group.The results of this study in some ways seem to me like common sense. Of course two treatments should be better than one. Hopefully though, it will help end the practice of psychiatrists just giving teens an anti-depressant prescription and nothing else. Although anti-depressants have greatly advanced the treatment of the physical aspects of depression, in my view they may have also made traditional methods of therapy seem less important. However, this study not only proves that cognitive behavioral therapy is basically just as effective as anti-depressants, but that the choice does not have to be between one and the other. Maybe some day in the future there will be a single miracle pill that will cure all depression, but until then it does not serve patients well to forget about lower tech methods of treatment because of new exciting drugs.
1 comment:
First of all, I would like to say that the study you discussed in your post is very relevant and also interesting. Your introduction of the study was informative and well written. I would also like to comment that the sources you linked to your link items are high-quality websites. However, I think the post would be more effective if you could add more link items, especially to paragraphs two and three of your post. You could link items such as “SSRIs” and “placebo.” This would be helpful for those who do not understand such terms. The graphic you have is appropriate for the post, but you should also reference the image. It would also be helpful to add one more graphic within your post. I agree with your inquiry regarding the study of “why it did not include a control group given no treatment or a placebo.” I believe in order to make the study more plausible, they “could have given a ‘placebo’ therapy in combination with the fluoxetine to see if it was the actual cognitive behavioral therapy that produced the changes” as you had mentioned. Your observations and comments about the study are excellent and pertinent to possible improvements for the study. I enjoyed learning about this study by reading your post and your analysis and conclusion are exceptional.
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