A Combination Of Cognitive Behavioral Therapy & Antidepressant Medication Works Best For Depressed Adolescents

A new study suggests that adolescents who are depressed may benefit most from a combination of cognitive behavioral therapy and an antidepressant medication such as Prozac (an SSRI or selective serotonin reuptake inhibitor). This combination approach is effective in reducing depressive symptoms as well as decreasing suicidal ideation (thoughts) and suicide attempts.

In this study, 327 adolescents ages 12-17 with moderate to severe major depression were randomly assigned to one of three groups: medication only (Prozac), cognitive behavioral therapy (CBT) only, or a combination of both. After 18 weeks, 85% of the participants receiving combination therapy were “much” or “very much” improved (compared to 69% of adolescents who took Prozac only, and 65% who received CBT only).

Symptom reduction benefits with combination therapy remained high across time. At 36 weeks, 86% of the teens receiving combination therapy were continuing to show improvement (while 81% of the Prozac-only and 81% of the CBT-only group experienced improvements).

Also interesting were the study’s findings that participants’ levels of suicidal thoughts and suicide attempts were significantly more common in the group receiving Prozac only when compared to the other groups. Only 2.5% of the adolescents receiving combination therapy reported suicidal thinking. In contrast, 13.7% of the participants in the Prozac only group experienced this type of thinking. There have been a number of recent media reports about the increased potential for suicidal thoughts and behaviors in children and adolescents who take SSRIs.

SSRI medications like Prozac work to prevent to the reabsorption of serotonin (a chemical messenger used throughout the brain and central nervous system) by neurons (cells in the brain and central nervous system). Research suggests that low levels of serotonin can contribute to a depressed mood. Preventing reabsorption (called “reuptake”) effectively allows the serotonin that is present in someone’s system to stick around longer and have an increased opportunity to regulate his or her mood. SSRIs are effective treatments for depression and anxiety, and they are relatively easy to use. However, they can have negative side effects (e.g., weight gain, nausea, vomiting, agitation, impaired memory, confusion, rapidly changing mood, and sleep problems). In addition, they do not provide a depressed person with adaptive coping skills, or teach him or her new ways of thinking and behaving.

CBT is a form of psychotherapy based on the theory that mental disorders are caused by maladaptive thoughts and behaviors. CBT therapists teach depressed patients to identify and change distorted patterns of thinking and making judgments, as well as behaviors that will improve their mood and life situation. A wealth of research suggests that this form of psychotherapy is effective with a wide range of people who are depressed.

The combination of CBT and an SSRI is particularly powerful because it provides a “one-two” punch against the powerful symptoms of depression. Medicines target brain chemistry problems that can impact mood. CBT steps in to provide a person with skills that they can use whenever and wherever they happen to be. These new skills can improve a current depressed mood, as well as help to prevent (or decrease the severity of) future depressive episodes.

Study Citation: March JS and colleagues (2007). The Treatment for Adolescents With Depression Study (TADS): Long-term Effectiveness and Safety Outcomes. Archives of General Psychiatry, Vol 64, Pages 1132-1144.