Depression Returns in Half of Treated Teens

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Thomas Barwick

Adolescence can be a difficult time, so it’s no wonder that an estimated 5% of US teens are affected by depression. And to make a difficult situation even worse, researchers now report that as many as half of even properly treated teens experience recurrent bouts of depression.

John Curry, a psychology professor at Duke University Medical School, found that adolescents treated with fluoxetine (Prozac) alone, cognitive behavior therapy alone, or a combination of the two experienced the same recurrence rate as those treated with placebo in a five year follow up study, one of the longest to look at depression in this age group. The teens showed a high rate of response to all of the treatments in the first few years, with 96% of them recovering from their initial depressive episode three and a half years later. But nearly half, or 46% of those who recovered experienced another round of depression within two more years. And while Curry and his team had expected that those who had a fuller and more robust response to treatment, or that those receiving the combination would be the least likely to relapse, they were wrong. Neither group showed any lower rate of recurrence compared to the other subjects. (More on Special Report: Kids and Mental Health)

“One of the things you hope for is that the treatment is enduring and that the effects will last,” says Curry. “And indeed, fewer of our subjects had a recurrence of depression within two years compared to some earlier studies. But as we followed them out over five years, a substantial number, about 46% of them do get another episode of depression.”

That rate is about the same as those found in previous, smaller studies, but those trials had not necessarily compared recurrence rates across different treatment methods. The fact that no single therapy provided protection against an additional depressive event highlights, says Curry, the episodic nature of the mental illness and need for continued monitoring and handling of symptoms. The subjects were provided 12 weeks of weekly treatments for their depression, then six weeks of weekly or every-other week treatments, and finally sessions once every six weeks for a total of 36 weeks. For the remainder of the follow up period, the teens were allowed to handle their depression on their own. “The results do indicate that we need to continue to develop better treatments,” says Curry, “and that we need to figure out what is triggering the second episodes and find better ways to help them cope with stress without getting into another depressive episode. I don’t think we need to keep people in weekly treatment beyond 36 weeks, but we may need some way to monitor their symptoms going further forward so we can institute treatment if needed.” Patients learn coping mechanisms with cognitive behavior therapy, but these skills may not be enough, or may need reinforcing as time passes. (More on How Not to Feel Lonely in a Crowd)

The findings also raise interesting questions about whether more intensive treatment initially, after the first bouts of depression in adolescents, could make a difference in lowering relapse rates. That might be especially useful in situations where anxiety occurs with depression, something happens more frequently in girls than in boys, and could explain why treating just the depression may not address the additional sources of mental illness in some cases. At the very least, says Curry, the study suggests that perhaps the length of time that adolescents are treated for depression should be extended to make the therapies more effective.

The original version of this post misidentified John Curry as a professor of psychiatry. He is a professor of psychology.

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