A talking cure for depression called cognitive behaviour therapy appears to cancel the risk of suicidal thinking or behaviour associated with taking antidepressant medication, according to the most comprehensive and long-running study to date of depression treatment among adolescents.
The study, published in the October issue of the Archives of General Psychiatry, followed for a year more than 600 adolescents being treated for chronic depression. It found that four in five recovered entirely, or nearly so, when treated over nine months with medication, talk therapy or a combination of the two.
Patients taking medication showed significant signs of improvement up to six weeks earlier than those who received talk therapy alone, but were about twice as likely to report feeling suddenly suicidal. The combination of the two therapies, the authors found, produced the most rapid recovery and protected against sudden suicidal urges.
For several years experts have been debating the risks to children and adolescents who take antidepressants like Prozac and Paxil.
In 2004, health regulators required that all labels for antidepressants carry prominent warnings that the drugs were associated with increased risks of suicidal thinking and behaviour in young patients, a link that many psychiatrists say has been blown out of proportion, scaring off patients who could benefit from drug treatment.
In this study, antidepressants lowered the risk of suicidal thoughts and actions over all, but significantly less so than talk therapy. "What this study shows, convincingly and for the first time, is that there are very good options for a child who is thought to be at risk for suicidal thinking," said Kevin Stark, a psychologist at the University of Texas, who was not involved with the research. "Psychosocial therapies do work on their own, with time.
But they also help prevent relapse, and this shows that they can help make drug treatment safer." In the study, which began in 1999, researchers recruited 654 youths ages 12 to 17 who had been moderately to severely depressed for up to a year or longer. The adolescents were randomly assigned to be treated with Prozac.
New York Times
