Talking, drugs best for depressed teens

Published: 2:27PM Wednesday August 18, 2004 Source: Reuters

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Talk therapy can allay thoughts of suicide among seriously depressed teenagers who are taking an antidepressant drug and the combination of therapies is more effective than the drugs alone, a study said.
   
The issue of whether the antidepressants introduced a new risk of suicide among children has been hugely controversial, with US federal regulators assembling data that could require warning labels on the drugs. Some studies have shown a link between certain antidepressants and suicide among children.
   
A Duke University study of 12- to 17-year-olds diagnosed with serious depression and treated with the antidepressant fluoxetine, cognitive behavioral therapy, or both, found thoughts of suicide fell markedly among the 29% of patients who had such feelings before treatment began.
   
Those who underwent both cognitive therapy and took fluoxetine, which is the generic version of Eli Lilly's Prozac, had the steepest drop in suicidal thoughts and the best response to treatment.
   
Cognitive therapy is designed to quickly break the patient's destructive mental patterns but does not venture deeply into a person's past, as does psychoanalysis.
   
Concerns have been raised about a potential link between the class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, such as fluoxetine, and thoughts of suicide, especially in the early stages of treatment when feelings of irritability or a lack of inhibitions may emerge.
   
The US Food and Drug Administration asked drug companies in March to include a warning on SSRI labels to encourage close observation of anyone taking the drugs for signs of worsening depression or suicidal thoughts. The agency also is assembling data on the subject.
   
British authorities have gone further by advising doctors to avoid prescribing SSRIs, except Prozac, to people under age 18. Prozac is the only SSRI approved in the United States for treating pediatric depression.
   
Suicidal thoughts
   
While fewer patients taking the drug in the study had suicidal thoughts than before, more exhibited what study author John March termed "harm-related adverse events" - such as a child screaming at his or her parents, banging his or her head on the floor when frustrated, or repeated self-mutilation - but which were not suicide attempts.
   
"While fluoxetine did not appear to increase suicidal ideation (thoughts), harm-related adverse events may occur more frequently in fluoxetine-treated patients and cognitive therapy may protect against these events," March wrote in the report published in the Journal of the American Medical Association.
   
"The one thing disturbing in the study is the adverse events; it does look higher among kids on just fluoxetine," said Thomas Insel, the director of the National Institute of Mental Health, which funded the study.
   
"Treating major depression is not like treating pneumonia or strep throat where you just prescribe medication," Insel said in a telephone interview. "There's a need for a relationship (with a therapist) so that both the parents and the adolescent knows somebody is available in case there's a crisis."
   
In the study, seven of the 439 children attempted suicide, though none succeeded.
   
Seventy-one percent of those who took fluoxetine and attended 15 hour-long therapy sessions over the 12-week study period responded positively. Sixty-one percent of those taking just the drug improved, as did 43% of those who only attended talk therapy. Among those taking a placebo, 35% improved.   

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