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Halo

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New Hope for Depressed Teens

Study finds that if first antidepressant doesn't work, try a second and add psychotherapy

TUESDAY, Feb. 26 (HealthDay News) -- If a depressed teen doesn't respond to treatment with commonly prescribed antidepressants the first time around, new research suggests there's still hope.

Switching medications and adding behavioral talk therapy turned out to be the most effective alternative, although just switching medications also helped many individuals.

"On average, these kids were ill for two years and no matter which treatment they got, at least 40 percent responded within 12 weeks," said study author Dr. David Brent, a professor of psychiatry at the University of Pittsburgh School of Medicine. "I really think the take-home message to families is if you don't respond to the first treatment, don't give up."

The study appears in the Feb. 27 issue of the Journal of the American Medical Association.

The issue of whether depressed or troubled children should even take antidepressants has been at the center of an intense public debate in recent years.

Some research has turned up evidence that kids on antidepressants have a higher rate of suicide ideation, meaning suicidal thoughts and behavior.

Heeding this data, the U.S. Food and Drug Administration in 2004 asked manufacturers of antidepressants to add a black-box warning to their labels warning about the increased suicide risk.

Recent research, however, has found that the benefits of antidepressants outweigh the risks for children and teens under the age of 19.

About 60 percent of adolescents with depression respond to treatment with antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Guidelines recommend prescribing SSRI medications, psychotherapy or both as a first-line treatment for this younger population. (The only SSRI approved by the FDA for use in pediatric patients is Prozac, but others are prescribed on an off-label basis).

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 many," she said.

But other types of talk therapy might also be effective, she added.
 

ladylore

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As an adult looking back on my teen years - I wish now I may have been put on an anti-depressant, as well as the counsellor I saw at age 12. Maybe the depressions wouldn't have had to have carried on for so many years. A bit more intervention would have been nice.
 

Halo

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I hear you Ladylore. I had a counsellor and social worker who didn't recognize the depths of my depression and continued to chalk up my behaviour as just being difficult added to the fact that they didn't listen to what I was telling them.

I too wish there was more intervention however I am glad to see that there are so many more resources available today for teens.
 

ladylore

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I hear you Ladylore. I had a counsellor and social worker who didn't recognize the depths of my depression and continued to chalk up my behaviour as just being difficult added to the fact that they didn't listen to what I was telling them.

I too wish there was more intervention however I am glad to see that there are so many more resources available today for teens.

That was the 80's for ya.
 

Halo

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Thank heavens for good 80s music or we would have had nothing :)
 

braveheart

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Yes, another teen of the 80s here. Another depressed teen of the 80s. Except it went unoticed, shoved under the carpet, hidden.
I had no support.
That's why I'm so passionate about helping teens today.
 

David Baxter

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I'm passionate about helping teens because they get treated like crap by a lot of adults, who then wonder why teens are so angry and disrespectful... :rolleyes:

Anyone remember that fridge magnet thingy for parents about "treat a child like... and s/he will grow up to be..."?
 

Halo

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I don't remember the magnet either but I do think you have a good point about teens being treated like crap from a lot of adults. I think that many times adults don't want to hear what teens have to say and don't think of them as having their own thoughts and opinions unless they are ones that the adults happen to agree with.

I also believe that unfortunately back in the 80s when we grew up that a lot of adults and even the teens for that matter didn't know much about depression or definitely not as much as the information that is out there today. I also think that the more popular the internet has gotten, the more information and knowledge people (both adults and teens) have which has helped.

I also can relate to what you said Braveheart about being depressed and it going unnoticed, ignored and/or swept under the rug.
 
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I also can relate to what you said Braveheart about being depressed and it going unnoticed, ignored and/or swept under the rug.

I can relate too. I was depressed as a teen and my parents refused to let me go on medication during my first hospital stay. The second time I did go on Elavil which at the time helped some.

But I always felt crazy. I'd never heard of anyone else self-mutilating and I was doing it way back then. I felt so ashamed. It's hard enough to be a teenager, but to deal with depression on top of it. I feel for them today.
 

Halo

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But I always felt crazy. I'd never heard of anyone else self-mutilating and I was doing it way back then. I felt so ashamed.

I remember those feelings all too well and wondering why I felt so different from everyone else. Like why they weren't escaping, binging and purging and SI but yet I was. I believe that it added to the depression as I felt alone and like a freak.

Again I am so glad that there are the resources and information available to teens and parents to obtain the help that is needed for teens.

I guess I was just born too early to be understood :)
 

ladylore

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What made me feel crazy is being treated like an adult in many ways (especially if I screwed up in some ways) and yet being treated like a child and left out of conversations and decisions that I really needed to hava a say in. It felt crazy making - "Be an adult, no don't be."
 

David Baxter

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What made me feel crazy is being treated like an adult in many ways (especially if I screwed up in some ways) and yet being treated like a child and left out of conversations and decisions that I really needed to hava a say in. It felt crazy making - "Be an adult, no don't be."

That's probably the #1 complaint I hear from teens in my practice.
 

ladylore

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I hoped this way of relating to teens/kids had gone out of style. It's too bad it hasn't - it isn't fair to treat anyone like that. Parents don't realize the damage that can be done.
 

David Baxter

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It's not just parents. I was waiting in line a few years back at The Bay doing Christmas Shopping. A young girl, maybe 15, had bought a gift and was asking whether she could get it wrapped. The cashier was, I thought, downright rude to the poor girl and then turned to the adult woman next in line and was almost sugary sweet. They were both paying customers. The only difference was apparently the cashier thought she could be rude to the teen with impunity.
 

Halo

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I too have witnessed such things and it is absolutely irritating and disgusting to see it happen. :mad:

One thing that I don't think that has changed much is that depending on how a teenager presents themselves and looks, can make all the difference in the type of treatment that they are given say in retail for instance. I know that I experienced that firsthand when I was a teen and even into my 20s and it use to anger me :rant:
 

braveheart

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What I got from my parents was, alternately "there must be something wrong with you" [you know the tone of voice?] and "there's nothing wrong with you".
Not that any of us had a name for it back then, but being withdrawn, hating myself, writing suicidal poetry, being irritable, crying, feeling unloved and alone.... we all knew there was something up.
But between dad telling me I needed a strait jacket when I was about 9 [I have no idea why, except this own rage got projected into me. I was in no way a violent child. More like mouse-who-doesn't-really-exist] and threatening and demeaning talks of 'trick cyclists' [psychiatrists] well I didn't get any mental health support then, at all!
 

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