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Antidepressant Seen as Effective in Treatment of Adolescents
NY Times ^ | June 2, 2004 | GARDINER HARRIS

Posted on 06/02/2004 12:49:11 AM PDT by neverdem

PHOENIX, June 1 — In the midst of a worldwide debate on whether depressed children should be treated with antidepressant drugs like Prozac, a landmark government-financed study has found that Prozac helps teenagers overcome depression far better than talk therapy. But a combination of the two treatments, the study found, produced the best result.

The study, sponsored by the National Institute of Mental Health, was the first to compare psychotherapy and drug treatment for depressed adolescents. Statistically, the researchers found, talk therapy — in which a patient discusses problems with a therapist — was by itself no more effective in reducing the depression than treatment with placebos. But when combined with drug treatment, psychotherapy appeared to provide added benefit and to reduce the risk of suicide.

The findings are likely to reassure psychiatrists, pediatricians and others who increasingly prescribe antidepressants to teenagers and children. Millions of young people take the drugs.

Experts said that the study was notable for its size and for the fact that it was carried out without financing by drug manufacturers. Data on the effects of antidepressants in adolescents is in short supply. Most studies of the question have been small trials sponsored by pharmaceutical companies and have failed to show that the drugs are effective for depressed teenagers.

"This study should put to rest doubts about whether these drugs work in teenagers with severe depression," said Dr. Graham Emslie, a professor of psychiatry at the University of Texas Southwestern Medical Center and an author of the study, which was presented here on Tuesday at a meeting of psychiatric drug researchers.

Still, the findings are unlikely to resolve the controversy over whether Prozac and similar drugs lead a small number of teenagers and children to become suicidal.

Such concerns led the Food and Drug Administration to warn earlier this year that patients taking the drugs should be watched closely for signs of suicide or other harmful behavior in the first weeks of therapy. The agency is reanalyzing suicidal events that occurred during drug-company trials of antidepressants in children and teenagers. British drug regulators have banned the use of all but Prozac in those younger than 18.

The government study, called the Treatment for Adolescents with Depression Study, involved 439 youths ages 12 to 17 who were suffering from moderate to severe depression.

The adolescents were randomly assigned to be treated for a period of 36 weeks with either Prozac, the antidepressant drug made by Eli Lilly & Company; a form of talk therapy known as cognitive behavioral therapy; placebo pills; or a combination of Prozac and talk therapy.

The researchers collected data on the subjects for a year, but have only analyzed information from the first 12 weeks so far. Of the youths recruited for the study, 378 completed the first 12 weeks of treatment. Their mean age was 15. Depression levels were measured using several common psychological scales.

Using one measurement scale, the researchers found that after 12 weeks, 71 percent of the subjects who received Prozac and talk therapy responded well to treatment, compared with 61 percent of those who received Prozac alone, 43 percent of who received talk therapy alone and 35 percent of those who received a placebo treatment. By another measure, talk therapy alone fared no better than treatment with placebos.

The researchers also found that patients became significantly less suicidal, no matter which treatment they were given. No patient committed suicide during the trial. But the risk of a suicide attempt among the patients given Prozac was twice that of those who did not, the study found. There were five suicide attempts among those given Prozac and just one among other participants.

Dr. John March, a professor of psychiatry at Duke University and the study's lead investigator, said that the findings showed Prozac's benefits for depressed teenagers and children far outweighed its risks. "The take-home message is that these adverse events are extremely rare,'' he said.

Dr. March acknowledged, however, that the controversy about suicide and antidepressant therapy was far from resolved. "We're all holding our breath to see what the F.D.A. is going to do,'' he said.

Psychologists, who are often the providers of talk therapy and who cannot prescribe drugs, are likely to be disappointed in the finding that cognitive behavioral therapy was found to be little better than a sugar pill. A recent major trial comparing drugs with talk therapy in children with attention-deficit disorder also showed that the drugs worked better.

But the findings of another study presented on Tuesday suggest that for some conditions, talk therapy may be more effective than antidepressants. That study compared cognitive behavioral therapy with Zoloft, an antidepressant similar to Prozac that is made by Pfizer, in teenagers who suffered from obsessive compulsive disorder. Those who received the talk therapy, the study found, improved more than those who were treated with the drug.

Dr. Thomas Insel, director of the National Institute of Mental Health, said he was pleased the results of the depression study were so clear. The institute spent $17 million over six years financing the trial. "The most striking thing about the study is that, in all groups, there was a dramatic decrease in the amount of suicidal thinking,'' he said, suggesting that all the therapies were protective.

Dr. David Brent, a professor of psychiatry at the University of Pittsburgh not involved with the study, suggested that another form of talk therapy called interpersonal therapy might have fared better than cognitive behavioral therapy.

In interpersonal therapy, clinicians focus on a patient's relationships with peers and family members and the way they see themselves. In cognitive behavioral therapy, clinicians teach patients to try to think more positively and do things that make them happy.

Dr. Brent said it was good news that drugs produced better results than talk therapy "because it's hard to get people into cognitive therapy anymore. They just don't want to take the time.''

The researchers said they plan to publish the preliminary results of the study this summer, with further analyses later.

Dr. Insel said that the most useful information from the study is yet to come. "We need to know which treatments work best for what kinds of kids and who may be the most vulnerable to the side effects,'' he said. Those sorts of answers would come from more data analysis, he said.

"We're going to get a lot out of this study that the public really needs to know right now,'' Dr. Insel said.


TOPICS: Business/Economy; Culture/Society; Front Page News; News/Current Events; US: Arizona; US: District of Columbia
KEYWORDS: antidepressant; depression; fluoxetine; mentalhealth; prozac; suicide
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Better living through government approved chemical treatments. Still, watch out for suicides.
1 posted on 06/02/2004 12:49:11 AM PDT by neverdem
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To: neverdem

I took Prozac once, in my early 20's. Can't say I noticed any difference when I was on it, but I sure felt suicidal when I came off it (when I hadn't before being prescribed it.) Go figure.


2 posted on 06/02/2004 12:55:45 AM PDT by KangarooJacqui ("by George, I think she's got it!")
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To: neverdem
Parents, do not drug your children. None of these medications has been followed over the long run on still-developing brains.

If your child has severe mental problems, get to a good psychiatrist immediately.

Drugs are the easy way out. Too often, they become the final way out.

3 posted on 06/02/2004 1:39:58 AM PDT by Dr. Eckleburg (There are very few shades of gray.)
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To: KangarooJacqui
Can't say I noticed any difference when I was on it, but I sure felt suicidal when I came off it

I have the same reaction from tequila.

4 posted on 06/02/2004 2:18:46 AM PDT by glock rocks (why is it kids can't read the bible in school, but can read the bible all they want once in prison?)
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To: glock rocks

And what medical condition do you take that for? :-P


5 posted on 06/02/2004 2:21:14 AM PDT by KangarooJacqui (In recovery from a liberal arts education since 1994.)
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To: KangarooJacqui

I don't remember. :o)


6 posted on 06/02/2004 2:26:13 AM PDT by glock rocks (why is it kids can't read the bible in school, but can read the bible all they want once in prison?)
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To: glock rocks
I prefer vodka, myself.



Da, Stoli!!!
7 posted on 06/02/2004 2:31:43 AM PDT by KangarooJacqui (In recovery from a liberal arts education since 1994.)
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To: KangarooJacqui

Da. I store it in the freezer.


8 posted on 06/02/2004 3:07:12 AM PDT by glock rocks (why is it kids can't read the bible in school, but can read the bible all they want once in prison?)
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To: glock rocks

Mine never lasts that long...


9 posted on 06/02/2004 3:10:47 AM PDT by KangarooJacqui (Perpetuating the myth of the hard-drinking, croc-wrestling Aussie since about five minutes ago)
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To: KangarooJacqui; glock rocks
And what medical condition do you take that for?

Sobriety.

10 posted on 06/02/2004 4:02:06 AM PDT by TN4Liberty (Life is a quagmire. Get used to it.)
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To: TN4Liberty

Cheers to that! ROTFLMAO


11 posted on 06/02/2004 4:06:02 AM PDT by KangarooJacqui (Perpetuating the myth of the hard-drinking, croc-wrestling Aussie since about five minutes ago)
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To: neverdem

Gardiner Harris FLIP-FLOPS as much as JOHN KERRY...

http://www.timeswatch.org/topicindex/H/harris_gardiner/welcome.asp



Gardiner Harris



• October 29 -- Times Bias Toward Bad Medicine?
Does the Times have a bad news bias when it comes to prescription drug coverage? Gardiner Harris' story in August concerning possible safety problems with anti-depressant drugs made the Times front page. But his latest story, which somewhat contradicts that premise, is buried on the last page of section F.

• August 7 -- The Times’ Anti-Drug War Continues
Gardiner Harris’ front-page story on anti-depression drugs is the latest in a series of prominently placed stories critical of the drug industry


12 posted on 06/02/2004 4:12:49 AM PDT by kcvl
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To: Dr. Eckleburg
If your child has severe mental problems, get to a good psychiatrist immediately.

If your child has severe mental problems, the first step, IMO, is take a hard honest look at what kind of parents you are. Becky

13 posted on 06/02/2004 5:22:07 AM PDT by PayNoAttentionManBehindCurtain (Proud member of the Lunatic Fringe, we love Spam, Uzi's and Jesus)
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To: PayNoAttentionManBehindCurtain
Not all psychiatric problems are caused by "bad parenting." Things like Tourette's Syndrome, autism, schizophrenia, etc. are largely genetic / brain chemistry conditions. Bad parenting of course can make them worse.

But adolescent depression is definitely something that IMO is over-treated with drugs. My sense is that a lot of kids are depressed by school and all the nonsense they often have to put up with there. Simply removing them from school, letting them "decompress" for a few months, and then homeschooling them probably would help more than a few.

14 posted on 06/02/2004 6:42:31 AM PDT by valkyrieanne
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To: valkyrieanne
Not all psychiatric problems are caused by "bad parenting." Things like Tourette's Syndrome, autism, schizophrenia, etc. are largely genetic / brain chemistry conditions. Bad parenting of course can make them worse.

No one was talking about these kind of problems, and throwing this factor in clouds the issue. I/the article was speaking of depressed children and drugging them.

But adolescent depression is definitely something that IMO is over-treated with drugs. My sense is that a lot of kids are depressed by school and all the nonsense they often have to put up with there. Simply removing them from school, letting them "decompress" for a few months, and then homeschooling them probably would help more than a few.

Why is heavens name are there soooooooo many depressed children out there now a days???? That's what we need to figure out. Drugs treat a symptom not the cause.

From the things I have read doctors try to tell people that depression is caused from a chemical imbalance. IMO, chemical imbalace is caused from depression, IOW's chemical imbalance is a symptom not the cause. Everyone I know, and I know alot of them, that is "depressed" started out by giving in to depression to the point that it ruled their life. IOW, I believe depression is a symptom of undisplined selfishness. Wallowing in self pity to the point that it does cause a chemical imbalance and boom now we can blame our depression on something besides our own selves.

Kids no a days get NO displine from anywhere. Parents are so focused on their own little selves, they either pay no attention to their kid, or give their kids everything they want and sign them up for all kinds of activities, and feel they have been a "good" parent, and THEN on top of it send these kids into the school system and expect it to be "fun" for the kids. Everything in this life does not have to be fun. Kids need to learn that life is not always fun, and learn how to deal with it. I believe a disiplined kid who learns that work can be enjoyable (different then "fun) will be a happier kid. But that takes work on the parents part.

There is a family in the neighbor hood where I live that has 3 boys. They are/were all on ritlin. Now they are all "depressed" and being treated for that. They are all 3 turning in to petty criminals. The oldest is 17 has never worked and did good in school when he was in a special program where it was "fun". Then he hit high school and was expected to go into regular classes and failed miserably. I'd say from the looks of it the other 2 will follow in his steps. The parents do nothing with these boys except haul them to sports events, oh and of course their counselors, and blame everything on "chemical imbalance"

I know I sound harsh:), I'm really not. But I'm sick of giving parents free passes on the things their kids do and turn out to be. They all want to blame things besides themselves, and find an easy solution to the problems so they can say they did "everything" they could, but continue on in their own selfish lives.

Becky

15 posted on 06/02/2004 7:46:32 AM PDT by PayNoAttentionManBehindCurtain (Proud member of the Lunatic Fringe, we love Spam, Uzi's and Jesus)
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To: fourdeuce82d; Travis McGee; El Gato; JudyB1938; Ernest_at_the_Beach; Robert A. Cook, PE; lepton; ...
The researchers also found that patients became significantly less suicidal, no matter which treatment they were given. No patient committed suicide during the trial. But the risk of a suicide attempt among the patients given Prozac was twice that of those who did not, the study found. There were five suicide attempts among those given Prozac and just one among other participants.

Can somebody explain the apparent contradiction about the risk of suicide in the last two sentences?

The last that I read was that trade name drugs have patent protection for seventeen years. Does anybody know if Prozac, which has the generic name of fluoxetine, still has patent protection?

Prozac is currently approved for the following indications: major depression, panic disorder, bulemia and obsessive - compulsive disorder. However, once a drug has FDA approval for any indication, a doc is free to use it for any other indication.

The researchers collected data on the subjects for a year, but have only analyzed information from the first 12 weeks so far. Of the youths recruited for the study, 378 completed the first 12 weeks of treatment. Their mean age was 15. Depression levels were measured using several common psychological scales.

Dr. Thomas Insel, director of the National Institute of Mental Health, said he was pleased the results of the depression study were so clear. The institute spent $17 million over six years financing the trial. "The most striking thing about the study is that, in all groups, there was a dramatic decrease in the amount of suicidal thinking,'' he said, suggesting that all the therapies were protective.

The researchers said they plan to publish the preliminary results of the study this summer, with further analyses later.

The sample size still seems small, the study seems quite expensive, and the results are not yet published in a peer reviewed journal, but it's on the Times' front page and making the hourly news updates.

16 posted on 06/02/2004 8:31:09 AM PDT by neverdem (Xin loi min oi)
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To: neverdem

I read the Slimes with a skeptical eye.


17 posted on 06/02/2004 8:33:48 AM PDT by cyborg
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To: kcvl

Thanks for the link. It seems the Times' editors have an addiction to attention grabbing headlines.


18 posted on 06/02/2004 8:42:51 AM PDT by neverdem (Xin loi min oi)
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To: KangarooJacqui
but I sure felt suicidal when I came off it

This is a very normal reaction to coming of these drugs, doctors usually use a "taper off" process to try to avoid this reaction.

19 posted on 06/02/2004 8:44:58 AM PDT by KC_for_Freedom (Sailing the highways of America, and loving it.)
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To: cyborg

Maybe cynicism is more appropriate than skepticism with the "paper of record" these days?


20 posted on 06/02/2004 8:45:38 AM PDT by neverdem (Xin loi min oi)
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