Antidepressants safer for teenagers when combined with talking treatment
Publication Date:03/10/2007
Introduction
Major depression is thought to affect about 1 in 20 teenagers. In severe cases, it can lead young people to think about or attempt suicide. Unfortunately, some medications used for this illness can slightly increase the risk of a depressed teenager thinking about suicide.
Now a new study has found that having talking treatment alongside antidepressant drugs can cut this risk and make taking medication safer.
What do we know already?
Antidepressant drugs were a major breakthrough in the treatment of depression. But as long ago as 1991, some of these medicines were reviewed by the drug safety authorities in the UK over worries that they could be linked to people harming themselves or thinking about suicide.
Most doctors now agree that, for adults, the benefits of antidepressants outweigh the risks. However, children and young people seem to be especially vulnerable to suicidal thoughts when they take some antidepressant drugs.
Doctors in the UK are very careful about giving antidepressants to children and teenagers. These drugs are only recommended for young people with more severe kinds of depression, or if a talking treatment (also called psychotherapy) hasn't helped. And doctors are advised to offer drugs together with talking treatment.
What does the new study say?
Researchers have now looked at a combination treatment that uses antidepressants and talking treatment in teenagers with major depression. It found that having both treatments worked slightly better than either one on its own. The study also found that both treatments cut the risk of young people thinking about or trying to commit suicide.
Tell me more about the study's findings
The study looked at 327 young people with major depression, aged between 12 and 17. A third of this group took an antidepressant called fluoxetine (one brand name is Prozac). A third had a talking treatment called cognitive behaviour therapy. This is a practical kind of therapy that teaches people to cope with unhelpful thoughts. The final third had both of these treatments together.
After 36 weeks, doctors reported that 86 in 100 young people having both treatments had "improved" or "very much improved". This compared with 81 in 100 people who just had talking treatment or who just took fluoxetine. Although talking treatment worked just as well as fluoxetine in the end, it took longer to start working. That's probably because the benefit builds up over the therapy sessions.
The study's most important findings concerned thoughts about suicide:
- About 6 in 100 teenagers having talking treatment alone thought about or attempted suicide
- About 15 in 100 teenagers taking fluoxetine alone thought about or attempted suicide
- About eight in 100 teenagers having both types of treatment thought about or attempted suicide.
So young people treated with fluoxetine alone ran about twice the risk of having suicidal thoughts as those having cognitive behaviour therapy or a combination treatment. And that's despite the fact that more teenagers having talking therapy felt suicidal to begin with.
Where does the study come from?
The study was done by a large group of researchers based at several universities and hospitals in the US. It was co-ordinated by researchers at Duke University Medical Center, Durham, North Carolina. It was paid for by the National Institute of Mental Health, which funds medical research. The study appeared in the Archives of General Psychiatry, which is published by the American Medical Association.
How reliable are the findings?
A big problem with the study is that it didn't include a group of young people who took a dummy treatment (a placebo). So it's impossible to say how much of the improvement came from treatment, and how much came from teenagers getting better over time, although that's unlikely. And because there was no dummy treatment, everyone knew which treatment they were getting. That means some of the improvement could come from the placebo effect, where people expect to feel better after treatment.
All the young people had taken fluoxetine or had talking treatment in a previous study, for several weeks before the new study started. Only teenagers who were helped by their treatment went into this study. So the real number of people these treatments work for may be lower than this study suggests.
What does this mean for me or my child?
In the UK, guidelines for doctors already recommend that young people have talking treatment at the same time as taking an antidepressant. The latest research seems to support this. Talking treatment seems to cut the risk of thinking about suicide that can happen with some antidepressants.
If you or your child is interested in CBT or another talking treatment, talk to your doctor. He or she will be able to explain what's available on the NHS. In some areas, there may be waiting lists for talking treatment. If you're considering private treatment, it's a good idea to talk to your usual doctor first. He or she will be able to give you advice, and may be able to recommend a psychologist.
What should I do now?
If you or your child is taking antidepressants, your doctor should check regularly for problems. You should see your doctor straight away if you're worried about suicidal thoughts or feelings, or any other side effects of antidepressants.
Although antidepressants can cause side effects, they can also cause problems if you stop taking them suddenly. If you or your child is taking an antidepressant, it's important not to stop taking the treatment without seeing your doctor.
To read more, see our information on depression in children.
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© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
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