Unfortunately, 40 percent do not respond to the first therapy they try, and there's little guidance on what to do next.
"There's just not that much research in kids, period," said Dr. Jane Ripperger-Suhler, an assistant professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine and a psychiatrist with Scott & White Mental Health Center in Temple.
For this latest study, the researchers chose 334 patients aged 12 to 18 years, all of whom had major depressive disorder and had not responded to two months of SSRI treatment. They were randomly selected to receive one of four treatment possibilities for 12 weeks: a second, different SSRI; a different SSRI plus cognitive behavioral therapy; Effexor (a serotonin-norepinephrine reuptake inhibitor, or SNRI); or Effexor plus cognitive behavioral therapy.
While the drugs were taken for 12 weeks; therapy lasted nine sessions.
There was a 54.8 percent response rate among those teens who switched to talk therapy plus either medication, compared to 40.5 percent for a medication switch alone.
There was no difference in response rates between Effexor and a second SSRI. However, there was a greater increase in blood pressure and pulse and more frequent skin problems with Effexor than the other drugs.
Ripperger-Suhler said that every time she puts a teen on an antidepressant, she refers them for therapy anyway. The results of this trial might prompt primary-care doctors, who are more apt to write a prescription and do nothing else, to also recommend therapy, she said.
One caveat, however, is that there are few really good cognitive behavioral therapists out there, nor is there any way to distinguish clearly among them, Ripperger-Suhler stated. "To do cognitive behavioral therapy effectively you really need someone who is well-trained and there aren't very
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