It may be hard to tell when adolescents are suffering from depression and when they are just displaying normal teenager attitude and mood swings. There is a vital distinction between the two, though, that should not be ignored. Depression, also known as major depressive disorder, is a serious condition that affects between four and eight percent of adolescents at any one time. It may be the result of a chemical imbalance in the brain, which is hereditary, a symptom of physical illness, or a response to sad or troubling life events.

Depression interferes with home, school, and family life, and affects thoughts, feelings, and behavior. A host of symptoms accompany the disorder including intense sadness, changes in appetite and sleep habits, withdrawal from friends and activities, falling grades, hopelessness, and worthlessness. Depression is of special concern because it contributes to the incidence of suicide, the third most common cause of death among teens.

Both drug therapy and psychotherapy have been the focus of many studies designed to determine the most effective treatments for depression, and there have been major advancements in the field. Studies have indicated, however, that treatments proven appropriate for adults are not always safe and effective for adolescents. In particular, treating adolescents with antidepressant drugs has recently come under investigation due to suspected links between some of these drugs and suicide. A study, which takes this link into consideration, is the Treatment for Adolescents with Depression Study (TADS), sponsored by The National Institutes of Health. Its goal is to determine the most effective treatment, or combination of treatments, for teenagers with depression. Results of stage 1 of the study are reported in the August 18, 2004 issue of the Journal of the American Medical Association .

About the study

TADS was conducted at thirteen academic institutions and community clinics in the US. It included 439 volunteers, age 12 to 17, who were diagnosed with major depressive disorder and reported, on average, moderate to severe symptoms. Patients were excluded from the study if they were deemed high-risk due to a suicide attempt, suicidal behavior or suicidal thoughts prior to the study.

Patients were randomly assigned to one of four study groups and then followed for 12 weeks. One group took the drug fluoxetine, a selective seratonin uptake inhibitor (SSRI) commonly known as Prozac; another took a placebo, a pill with no active substances which is given instead of medication; a third group received a type of psychotherapy known as cognitive-behavioral therapy (CBT), which teaches patients how to reduce negative thoughts and reinforces positive behaviors; and a fourth group had a combination of fluoxetine and CBT.

Patients assigned to the drug groups were monitored by a physician during the 12-week study, and those receiving CBT met regularly with a therapist.

The Findings

After 12 weeks of treatment, patients’ depression symptoms were measured using a depression rating scale. All four treatment groups demonstrated a reduction in depressive symptoms, including suicidal thoughts, but the group that received fluoxetine and CBT produced improvements that were significantly better than either treatment alone. Positive responses on the depression rating scale (indicated by the choices of “much improved” or “very much improved”) were reported by 71% of the patients in the combined drug and therapy group; 61% of the fluoxetine-only group, 43% of the CBT-only group, and 35% of the placebo group.

There were no suicides during the study, though there were 23 suicide-related events; nine of these, the highest number for any group, occurred in the fluoxetine-only group. Although the study doesn’t clear up concerns about the link between SSRI and suicide, it does suggest that pairing SSRIs with psychotherapy may reduce suicidal risks.

What this means for you

It’s important to identify and treat depression as early as possible. If you are concerned that you or a teen you care about may be suffering from depression, talk to your doctor about getting treated. Because depression stems from a variety of sources, the first step in treatment should be a full physical and psychological examination. Treatment plans are individualized for each patient depending on the severity of symptoms and other medical factors.

Although depression has no quick fixes, the TADS study showed that treatment can be effective within twelve weeks. These encouraging results provide hope to teens suffering from depression, as well as their families. This study highlighted the importance of treating adolescent depression with a combination of therapies. In addition to fluoxetine and CBT, other effective SSRI drugs and forms of psychotherapy are available.