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Reuters, February 26, 2008

Teenagers whose initial drug treatment fails to combat depression, which happens in four out of 10 cases, can be helped by switching medicine and adding psychotherapy, a U.S. study published on Tuesday said.

"The findings should be encouraging for families with a teen who has been struggling with depression for some time," said Dr. David Brent of the University of Pittsburgh who headed the research.

 
"Even if a first attempt at treatment is unsuccessful, persistence will pay off. Being open to trying new evidence-based medications or treatment combinations is likely to result in improvement," he added.
The study, published in this week's Journal of the American Medical Association, was conducted from 2000 to 2008.

 
It involved 334 patients aged 12 to 18 with major depression who had not responded to two months of treatment with a selective serotonin reuptake inhibitor or SSRI, a type of antidepressant.

 
The teens were variously switched to another SSRI such as GlaxoSmithKline Paxil (paroxetine), Forest Laboratories Inc's Celexa (citalopram) or Eli Lilly and Co's Prozac (fluoxetine); given a different SSRI plus cognitive behavioral therapy, which emphasizes problem-solving and behavior change; switched to Wyeth's Effexor (venlafaxine), another type of antidepressant called a serotonin and norepinephrine reuptake inhibitor or SNRI that has been found good for treating drug-resistant depression in adults; or switched to Effexor plus therapy.

 
The researchers found that about 55 percent of those who switched to either type of medication and added therapy got better, while 41 percent of those who switched to another medication without therapy also responded.

 
There were no differences in their response to the two different types of anti-depressant drugs used or any differences in the way they were helped by the three different SSRIs involved.

 
"About 40 percent of adolescents with depression do not adequately respond to a first treatment course with an antidepressant medication, and clinicians have no solid guidelines on how to choose subsequent treatments for these patients," said Dr. Thomas Insel, director of the National Institute of Mental Health, which paid for the study.

 
The results "bring us closer to personalizing treatment for teens who have chronic and difficult-to-treat depression," he added.

 
While more than half of the teens in the study said they had thoughts of suicide before the research began, the treatments used appeared to have no impact on such thoughts, the researchers aid.

 
That finding, they added, is consistent with other studies that have found that considering suicide does not necessarily subside when the depression eases.

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